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HomeMy WebLinkAbout0167DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 4. -1 -56 BOX 2 00167 1 � Jr A V0160. =� 00167 r - tr 3t + F y Y�� xrC r +� RIM , a `fib r s 6 � T 5,.� t r5N3 K yam_ 4\ t1 '1 ��w+�. !✓ /� 1• r , � 1 t� y� 7,77— T r tK y��,•�r` ltd .1 d 6',./' 4y s s . � � t 8J u... rC a•F s b al {'rte � !y /%2ry.A..� r� L 1,V� IN s " JT:W. wavy Shk v m <5 a r a h 5 L1''•s,+,s�z � fit.: c t r s 'i � � �s.t,.� �� 1 � ' � + d 5 x�r_ „. J I ' , !�'•a>�.��iR.{c's�f?!; 3^;t ?,": h'S'�� ?w�+Vfrr ,r.r r.k �i s�'mae..r�a•E'{0 c'}.;a�r-r',._�. ,. .''+�...`.ra>= y'1r, -e>� Kam: a ` y t �j1 sr x i rCi Ow r or Purchaser of building ;;;:. Constructed oak Locatio r r Building Type Section Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, w orkmanship, 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 r 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 occupant of the building'utilizing The undersigned further agrees to accept as conclusive the determination of the Director 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. the occupant of t e building a i.zing the system. /i J. /% n . Dated this day of 19* Signat 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. BACTERIOLOGY -.PAW T.OLO'GY , VIRO-LOGY - 4 " - - ANTIBIOTIC USED •v y SSOURCE:OF WATER IAL-4p �REQUEST,p W239 ;[]r800d- { ❑,SMEAR. CULTURE Village Pharmacy Water tGS.t ❑ Putum ,-❑ Rout' e; - Bill S'chreib6r ❑. o :e. ❑ T.B. - '. ❑• roaf ❑ Diphtheria, pine y w Win dale, NY ❑fungus g . ❑' ece :_ °❑ ✓: 4%16.%74 us. rom - ❑ t er ❑: _ El PUTNAM DIAGNOSTIC LABORATORIES r; p Ova and Parasites - '❑ Viral. tudies' °'... 10 STON'ELEIGH -AVENUE ', CARMEL;,N:`Y, . _ C3 SENSITIVIT•Y s. es T. STAPHLOCOCCUS.. ' :--7 p Aerobacter orainphenieo _ :,; ". '❑ Non.114 o.•Coag'Tofollow ❑ Corynebactenu, "•'- , ` o istin- u p ate ,. -" . - ; ,..� '_❑ -,Remo yNc -Coeg ;To;Fo low a= :. ❑ Escheriehia' ee omyein 7 07R-1-66simla, " i y - ►ostrePtomyci'` x: ❑ ".= Negative ' ; -, ❑ :ParacoI_' Bact., ryt romycin > '` ; s R P . OCC S,.' HE, OL -❑ Proteu, -,. Nis m :cin' ❑ Alpha, Cl Beta ", '❑ Gaining: " Pseudomonas `Nitrofura�toin :. _ - ;.::- ❑ 'Enterococeus ' _ „ ,:: Entere Paehogens:.:.: O_ xacillin - s _` .0 p Pneuinococcus. ❑'xFound _... . ana 6 .: ; ^_ ,. ❑ Neisseria ❑`,Not: Found_ y' = OHM_ ❑ Hemophilia t.; Tetraeye ins TUBERCULOSIS SMEAR' ` . TUBERCULOSIS CULTURE' riacety o can omycin ❑ cicl -Fast • Not Found, ❑ .Neg F.or Acid Fast mpiu m.,, „. °' ❑ Acid`:Fast - F.oun [3 os �.: r _7- ears, Routine Neg. ❑ O P; Not Foun Smears, s ci u tu-res, - O osifive or -' Coliform ` BaCi11i 'Less than 2 2 f At the time of �examiriation wager was 'of good quality. r _ WELLI COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH 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 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 Robert tilJeil ADDRESS . South Quaker Hill Rd Patterson, T v LOCATION OF WELL (No. & Street) (Town) (lot Number) PROPOSED "'USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT PUBLIC 1-1 SUPP Y El INDUSTRIAL ❑ FARM AIR ❑ CONDITIONING ❑ TEST WELL (S(Specify) DRILLING EQUIPMENT COMPRESSED ® ROTARY El A R PERCUSSION CABLE ❑ PERCUSSION ❑ (Spe E y) CASING DETAILS LENGTH (feet) 21 Ft; 0 DIAMETER (inches) 711 WEIGHT PER FOOT 26 Lbs o ® THREADED El WELDED DRIVE SHOE E YES ❑ NO WAS CASING ®YES �ROj TED? LJ NO TEST HOURS 1:1 BAILED ❑ PUMPED ® COMPRESSED AIR G.P.A. YIELD (G.P.M.) 60 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 20 Ft e DURING YIELD TEST fleet)' Depth of Completed Well in feet below Land surface: 220 Ft. _ SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) 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 t If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 12Z9/7 2 DATE OF REPORT 1 2/2$/73 WELL DRILLER (Signature)c -i WT, COUNTY -. DEPARTMENT OF H] i Dfvis�on of 'Envifonmental Hea/tgh SefKIL; Carmel N CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at �— ' yr t✓ —�� n Section Subdivision Lot n Owner �' ��� °�+ I 1 —�' Address '. Bg T wid m ype `�►-- v"y Lot Number ,of Bedrooms Total, Habda Separate Sewerage`System:. to con§ist ofd ® Gal Septic Tank To be constructed by Address Water Supplylic Supply From Private Supply to be drilled by Address Other Regwrements T - ' represent that I am wholly and completely';responsible for the design and IocaUon ofI the proposed sj atiove described will be corstructed'as shown on the Spproved amendment there to and :m accordance w� County Department of 1lealth, `and that on completion thereof a Certrf�cate of Constructwn Comp. be submitted to ahe Department and a wntten yguarantee ,will be %furnished the owner his Successor place m,good operating condition any part of said sewage tlisposal system dunng the perwd of tvi ance of the approval of the Certificate of: Construction Compliance of the or�ginal> system or any i � �' rf i,., :em -t: 1 •-` r tt♦ 'S•�t \tit \♦•°. \\ W t"' y'a u a* d a ,}'\ I . \� �♦ ♦ \ �t. \1 x f+'a (Ji 7 `�`rr���� , ��•., �i�1 `♦ t °`�";� = '� �: + e.\itt t;(•„ jli ri.' 1j. t hhtj, v _�I {I7`�f 1 c,Jr /1.. 4*, ,y,I , ,I , /;,/ {{ ` _ •L V� \ ,��,f:, \ \ 'l tI / �'"�'��+ � � �.'hl a ` \.% r7v_� � l � ;'�t�l r,•� t t :\ i'�,' - i , S \�' � ':.- .,�`,'O`u } rf �: /r l r, i� 1>�•,6I ul Cam„ ra i\ )� \1 ? 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Revised 1958 MN...- GN t Polyconic projection., 1927 North American datum C( ­­ r, a _,; 1.,,< 4 ,,,, Mow Vnrk rnnrr(innta system. 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 N0. '51,211-63 j Owner F,L.CA&t0V_ 06:14t_ Address PoiOY%,j 11tb—"�'&]. �,�,; Located at (Street 6dicate �U 9LF1IF_1Z Vr.Sec. �� Block Z- Lot 3 nearest cross street) Municipality O Watershed ceo-, 0V, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop apse Time Min. Depth to Water From Ground Start Inches Water Level Surface in .Inches Stop Drop in Inches Inches Soil Rate Min. /in drop 1: a C,.00,0 S i Z 13 i 5/1 23`oo 4-- S/i 4 3 i3 5 3 : tca 3:Z1 1 Y2 1 3z 2 3 4 5 3 5 Notes: 1) Te 'sts 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. DEPTH G. L. 6" 12" 18" 24" 30" 36" 42" 48" 54" 60" 66" 72" 7811 84" TEST PIT DATA REQUIRED TO BE_SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date Soil Rate Used t -L- L \'1Min/l "Drop: DESIGN S. D. Usable Area Provided S 6^X�1--0 No. of Bedrooms Septic Tank Capacity C, t "A Absorption Area Prov d By2� L.F.x24" ,, �w tY drench. 1A Address gnature THIS SPACE FOR USE BY .HEALTH DEPARTPEM ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by P , Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property c Located at Date -10- o9-- -TQ, Sectionl -M Block - Lot Gentlemen: I 1 This letter is to authorize a duly licensed professional engineer e/ or registered architect (Indicate 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 promulgatel by the Commissioner of the Putnam County icj✓aittucitt of Health, and to sign all necessary 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. Countersigned: Very truly yours, Signed Owner o Property Address Telephone �4f`3 _� ? ,ii `� Y �{ �• `T' >W�� .r� ni , - ` ie Sfe�1:;, "f f & rJK rr " .� �} � . "�•!� . F iL .e, {F ' c . 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DISPOSAL SYSTEM GRADES REFERENCED TO FINISHED FIRST FLOOR ELEVATION., UNLESS OTHERWISE NOTED. ROVLC LA�4APP S.S.D. SYSTEM' FOR rl A L. t- I so,' HOWARD A. KELLY, JR. q< A. K ASSOCIATES No -DATE elf CARMEL .NEW YORK 0,21972 4 NOV TAX MAP NO. S .13LK,.NO. LOT NO. co-01 Ll" 1 TOWN OF PUT," . ......... . .. OF DIVISION taw N\,,R0NMEN_flll '"'v"EttVICEJ n &Y CI.A J, I Scot!Al. golLb—, 389,9 4 Chk C! Date 0,0wfmq No. OF NE Traced ApVd FT NHOLE COV r It -00MV AD. LEVEL JUNCTION BOX 4 MIN. COAL.. r 4 1 sn I c, TAii4K_ 11 D E va CRIN I CAST IRON SAN[ -4 SECTION TARY TEE -r, i. 4 N 2 TYPICAL CONC. PRE-CAST tONC. SEPTIC 'TANK 6INF. 8"C.C. D/W 1. 351.75` m - ---_----­- 0 GRD; LEVEL Z - EA 1 11 311 ACPI1ILL JOINT A - A -,VLR BLDG. 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