Loading...
HomeMy WebLinkAbout0098DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.19 -1 -44 BOX 2 y „ J I T r �' ��,, 16 NN IN IN No r er lv� NN rlll•: PUTNAM COUNTY - DEPARTMENT 'OF HEALTH Division of .Environmental Health Services, :Carmel, ' N. Y.- 10512 CERTIFICATE OF' CONSTRUCTION COMPLIANCE. FOR SEWAGE DISPOSAL SYSTEM. IR ttejrsorl Town or;Village. Route 292 ,<.(formerlY `27 6 Tax Ma 2 - 4 Located. A'i% 5'�iitil_ Block owner Mr & _Mrs . Wm: C1 ark " coc 2 1 ,: "' :50755 Roy Paulson Address Holmes, NY 1. Separate .Sewerage System • builtt /bey Consisting of fVOOGaI. Septic Tank' -- 299 Imeal Fget.X.6-1 nCh width trench„ - ` Other requirements ��a Area - 90' a, x 30`I W. x - 36" peep, Water Supply, ,• V public Supply From. _ ' p �+ Beal T X Private Supply. - Drilled .BY ' ! R. F .. Beal � son' S, ' Inc., Address .Brewster, NY } R- game ' ::. Three 3/27/T4 (Renewed) ,"Building Type No, of 'Bedrooms Date Permit Issuetl ! _ . i Has Vosion Control Been Completedr• US I certify that the'system(ij as listed .serving the above premises were, constructed essentially as -shown on`the -plans of the.completed work!(copies of which are j attached) And in accordance with the standards, rules and ,regulations, plans filed, nd the:permit issuetl by Putnam_. County • Department of. He$Ith.; . Date . UU I�/ 1,97`t -x Certified b•Y /address :R. D 6:.. Box: 3 C .'Lic'e'nse 'No. 29206 _Any person occupying premises served by,the above system(s) shall pro IV .take such action as may be necessary to secure the,correction of any unsanitary , =conditions resulting from ' °such "asage.-? Approval of the separate. sewerage, system shall become* ull and void as'soon'as a public sanitary'sewer becomes-., zvailable and the approval of the private water supply shall-become null and void when a'public-water, supply becomes available. Such approvals are': Isubject:tb modification or, change when, in the - judgment. of the mis inner of:Health, such•revocmo icaUOn or change_`is necessary Date' _ Title. - LIA 11 M C. L A ii h,: N HPAL-T+j -.'C0-,,,1PLF- TION 11 L-.OoriT PUU'Al' COU TY� DEV�,RTMEM.T Or -)nrnentll 0 rvicas, Division of Unviit I Hoolit, S COUNTY. OFFICE LIUILDING - CARMEL, NEVV.YOfij< "(hie 1'ePo--t is'.to he completed by Well driller and stj!,-1--.6iled.to County Heafth Dr,,partment together with.laboratoty report.of I analysis oi..vvater.sample indicating water is'of satisfactor'y bacterial quality before certificate'of construction C'ornplianqe is issued. REPORT MUST 13E SUBMJITTED WITHIN '30 DAYS OF WELL COMI LET1014. Y, WNER PAULSON- BLDRS • a. Clark P b Box 168s Carmel, New York (Town) (Lot Uumbor) 10:4 ELL Route 292 -Patterson,.New York BUSINESS" 0 BUSIK El TEST Y41L, FX1 if PROPOSED DOMEST f5TAFAISHMEN T FARM USE OF WELL PUBLI C AIR OTHER El ❑ (S[,.C;(Y) SUPPLY INDUSTRIAL CONDITIONING R111.046 COI,�PRESSED. CABLE . % * ❑ mi rp ❑ PERCUSSION (Specify) El El UIP;?,r.NT, ROTARY— Alf! PERCUSSION (inches) WEIGHT PER FOOT VVI V * h .'CNGIH peef) I OIAME)Li: E SHOE '-YAS CASING QVr.1Ui —IN YES! 140 READED _E1 LWL LD ED DYES 1 0 TH j q -METAILS _iX HOURS G.P.A. YIELD (G.P.M.) . 7 UMPED COMPRESSED AIR, BAILED' P five' 5 25. GPM V a1 W AT F. P - 'LEVEL MEASURE FROM LAND SURFACE — STAI IC (Specify DURING YIELD TEST [10.1) Depth of CompleA.el Well fact below Land sur face; 95' ftli :- ft- 3 2 MAKE LENGTH OPEC. TU /.QUIFER (feet) CPEF.N T DETAILS SLOT SIZE, DIAMETER (Inches). AVE L Diameter at well including me 9 -fol pack gravel (inches): GkAV . EL SIZE (inches) fluol) 10 (feet) IAND SUFFACE1 FORMATION DESCRIPTION skoich exact lacatidn of wall with distances, to, at least two pormanow landmarks. rc to -z2- 2 Drilling in overburden-.' -arth A -1it': solid rock 'at two feet ax in = setting R 30.. rilling rock -asing grouted 95 .—ranite " 31rilling in rock'� X • , ve. M If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE IN'PAIII-WELL COMPLETED WE DATE OF REPORT WELL DRILLER (Signaturel, /q/7h 1,/97/74 S. BREWSTER LABORATORIES Box 224 BREWSTER, ; N. Y. r} WATER ANALYSIS REPORT SAMPLE .No. 3216 SOURCE" WL ll iam Clark - `hose bibb - wel l supply, Route 292 Patterson, N. Y, COLLECTED: June 26, 1974 ` BY: Paulson Builders, ;Inc. BACTERIOLOGICAL EXAMINATION , Coliform Count, MF Method Q per 100 ml. M1 This ' rerult indicate; the rource of : the fanrpla war of m6ifactery sanitary quality when the mmple was .collected. i r/` Mr. & Mrs. William Clark Owner or Purchaser or Building Paulson Builders, Inc. Building Constructed by Route 292 Location - Street Frame Building Type Patterson 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 ne ligent act of the occupant of the building utilizing the jsy� -t�_`� Dated this _ day of 19 7 Signature r L Ave6" If corporation, give name and address) Title 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 Mr. & Mrs. William Clark Owner or Purc aser of Building Paulson Builders, Inc Building Constructed by Route 292 Location - Street Frame Building Type Patterson 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 2nd day of July 1974 Signature L Title 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 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental. Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR- SE,NAGE DISPOSAL SYSTEM Patterson Town or Village Route :216 Located at Section Block c Subdivision Lot Job 5075.5 Owner Mr. & Mrs. W. Clark Address 302 Washington Ave: , Building Type Lot Area 41101 A. Brooklyn, NY ,11250 C Number of Bedrooms Three Total Habitable Space 1600 Square Feet Separate Sewerage System to consist of 1000 Gal. Septic Tank 300 lineal feet X 36 inch width trench To be constructed by Address Water Supply: v Public Supply From X Private Supply to be drilled by ? Address Other. Requirements Fill Area - 661 L. x 421 W. x '36" Deep 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 regulations of e Putnarh 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 thedate 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 th standards, rules and regula -ions -of the Putnam County Department of Health. 25 March 1974 Date Signed P.E. X R.A. Address RD 6, Box 353, a el , NY 10512 License No. 29206 APPROVED FOR CONSTRUCTION: This approval expires o ar 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. ed for disposal of domestic sanitary a -vale ter s Fly. � Date OF PUT NAM COUNTY DEPARTMENT OF HEALTH ' Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE] DISPOSAL 'SYSTEM Patterson Town or Village Located at Route 216 Section Block Subdivision Lot Job 50755 Owner Mr. & Mrs. W. Clark Address 302 Washington Avenue,. Building Type Lot Area 4..1.01 A. Brookl-yn:;:: -N.`- Y- .1:1.205 :. Number of Bedrooms Three Total Habitable Space 1 V00- _ Square Feet Separate Sewerage System to consist of 1 000 Gal. Septic Tank 300 lineal feet •X 36 i neh. wrath trench ^, To be constructed by ?. Address ?^ _ Water Supply: X Public Supply From Private Supply to be drilled by Address Other. Requirements Fill Area - 661 L. x .421 W • x 3611 Deep 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 regulations o e 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 thedate 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 st ards, rules and regulationsoof the Putnam County Department of Health. Bate 24 July 1972 Signed P.E. X R.A. Address R.D. 6 B. 353 Ca. , New York 105 License No. 29206 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 aa% new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. rlatn �� �C�f/ll� ' � /� / � Rv/ � li r�O -.i - ^ - ✓.�� -/� /.lip ��a T:YIn / .--_ / / �-.., �- .P T\ C0'_' lL' Or - -L, T H DIVISION: 0 E\ 'Vl� O\-\,f7 . 1; r _ _ 7tgC DESIGN DaT� SHEET JLIPARATE SE7`GF DIS :;SAL S Y-STE.. FILE «0. G'`•:= or m,% ��/^l Lt/. i : Cy "e Add I- es Located at (Stye: t ). .��� _ Sec Bloc' _ Loy (In d.ica -- _ es z c_ vs'J Lr eC -) riunicipality� �S' 1M ;'a�ershed 00766 COI; °SRC J JaTIO_ti TEST. D �T . } ODI ?^ ' 0 ° �L= ED � I T'j �. 'DLIC aTT�' O 2 I1.s /_ — -- Note ,�u ;, CLCC �_ TI` PE?COLT10�: _ PEP.CCL'� _'_ .'fin tlaQS2 Le?-- o S;,Co, �:a�er L ='.'el No. time Fro- .Jro,,na S� - = =ce . - . I-c:.es So.1. _` Smear Stop 'lin . St�� Stop Drop is `tin /i; . d ~oo Inches Inc *.es Ir.c =es. 3 �1_ /� �'P /'I lip 4. S - -- 4 s 2. 3 -- - -- 5 ; No LeS . t p. pr; "-�..: 1:.'j l,�l 4_i� O i� �.L. Y J -�Le r"1=, Soi `r,? Les. _ e ob- 1) 'Pests i ' b r ��� �6d � s deg �n 1: - -y s.-.o:..= .. e _ ^ 1nJ.�i "a.t e C t oe�,col_atio- L ^' ` of _ _ - ^.11 d =' _ �O b jL'.' °' i0i 2 I1.s /_ d in L IA- 4 s 2. 3 -- - -- 5 ; No LeS . t p. pr; "-�..: 1:.'j l,�l 4_i� O i� �.L. Y J -�Le r"1=, Soi `r,? Les. _ e ob- 1) 'Pests i ' b r ��� �6d � s deg �n 1: - -y s.-.o:..= .. e _ ^ 1nJ.�i "a.t e C t oe�,col_atio- L ^' ` of _ _ - ^.11 d =' _ �O b jL'.' °' i0i All TEST P-- D':Tk OUT TD ;0 7. ��L`iIT.TEO ,:I:H ;PPLI.CalIO D== CP.IPT10\ O' S'?�LS. - \1ER =?� t`. - T :{OLE DEPTH HOLE \0. .HOLE \0. HOLE \J. G.L. PliTi`a , OP 6" 12'' "P-f- I(:al rlinr?''a(� '.:•. :. 1S Tr 2 4' 30` 1 36" 42' (,fJgrr 49 " if .1' �y 60 66" 8 4" INDICATE ii_•V L AT .: -f"1Cr G -1 O7\D :;' TER TS t':COUNIIERE'D ^1`-_ �-('. ; f�._ i.� r ��i�.j Tr?T = YYI*�r �F 'T'.r.. -,.� Ou 'TE�D�0wo 1 iti ICS - L� - TO :nl .r. :� �^. I E� =- ✓y BE__�� . TESTIS �_�DE J_L. 7J ate` %- - - Soil. katc `;i - --.- �__ -_ Dr.o�,: - L V .• _.� S.D. ':'s __?e . ` -rep P�!1 'tee ^iii► �'� NO. 0- Le roo--.s Semitic Tank � Ca��c -tl' X00 Gals. T;�p- Jto Absor ti.o n rire,. t'-- ,j,ided L.F:.Y2' 36'' ✓ widt -h trench. Other fk �i►.� �tl. _ si if ;ico n.. {i I%ntlss,. PX. o ¢� - ? o :Zre �. Al R , D,�6 , B. 53 Address `- an fi; - M At pp 292�b �7 oFTHE S�MILO .._ Date PliTi`a ?I CCU\ 't' DE?_- `.Ri'��` <i OP rEA' LTA qf-r "P-f- I(:al rlinr?''a(� '.:•. :. pp 292�b �7 oFTHE S�MILO .._ Date T, S s le �wg)v y 'uivejor..no.ted' b-6 16 i. struo6r -e lc� a d' t ro 7— we I I' I oi:i!o` t a d -'b,Y S'u ry yo r s surge y Ino)(n4eys mesu.r.e iin* WILL L -11 Tar.-k, v6xps, piti;:*gollo'ries-ai'late"Va"is i6�ccstid b; :'Controctor: Eng:, H e Ilh dd,pt: Iia I a I nsp.ect Ion by: 'Health al I h dep t date: _ =71L. Engineer date LIN NOTES: �, X — K 1 A2- 7 Q '-) APPROVED IL3 1974 DIMENSIONS A A C A D Le L D c— A E B E A F B F A ki A H H A K SANITARY SYSTEM- DESIGN "A'S BUILT" OWNLR: LO C4TION-'§trect: _ K Q-sj 7 Tow _County: --5,t ote � 2u- S(J.BVIV IS ION /a I ock.. LOT.. Ns :Z, I o Surveyor 4p r 292 °b Dro Dote Scale 7— bN gi IDwg. Nt JOHN H PR E* N T-1 S S P F �T i L L �, X — K 1 A2- 7 Q '-) APPROVED IL3 1974 DIMENSIONS A A C A D Le L D c— A E B E A F B F A ki A H H A K SANITARY SYSTEM- DESIGN "A'S BUILT" OWNLR: LO C4TION-'§trect: _ K Q-sj 7 Tow _County: --5,t ote � 2u- S(J.BVIV IS ION /a I ock.. LOT.. Ns :Z, I o Surveyor 4p r 292 °b Dro Dote Scale 7— bN gi IDwg. Nt JOHN H PR E* N T-1 S S P F FORMERLY .BUECHEL 4- _ N/F FITZG.ERALD od• 426. N76053'-44"W 10.923' /15.26 iron pin 113.42' . } iron pin a f ti Linon pin ^I 1 �. �4j ` we // ' 9n�'den shed CO v, home ui /ding . I alb roof only A REA = 4. /d/ ACRES ® 0 004 �K� \ ,. o �. to a o� ire. 144 Q) cb rnen o • cr � Ira - �- - -fence post 1 "yes � y b n r FORMERLY .BUECHEL 4- _ N/F FITZG.ERALD od• 426. N76053'-44"W 10.923' /15.26 iron pin 113.42' . } iron pin a f ti Linon pin ^I 1 �. �4j ` we // ' 9n�'den shed CO v, home ui /ding . I alb roof only A REA = 4. /d/ ACRES ® 0 004 �K� \ ,. o �. to a o� ire. 144 Q) cb rnen o • cr � Ira - �- - -fence post 1 "yes