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HomeMy WebLinkAbout0209DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -11 BOX 3 I Nam J IN . .� L �T . IN PUTNAM, "COUNTY "DEPARTMEN OF, HEALTH H Division o'f:.Environmental Health Services Carrhe%` N. Y 10512 - CERTIFICATE :jOF C6NSTR.UCTION COMP_LIANC.E FOR- SEWAGE .DISPOSAL SYSTEM Patterson I Town or Village B4 rch:'Hi11 Road Located. at _ echo Bloy S ck i Owner Robenat C6ntractors :Inc - tot - 3' Job SO l9 r 318 Separate Sewerage System bwlt by S Septjc:rSystems, �nC Address New Rochel 6, NY 1250 402. 36 .inch Consisting of Gal :Septic Tank lineal Feet X' width trench 3 , Other requirements ' Water Supply: PUblic Supply From v Mi'11 Aril1ing, Inc: { Pnvate Supply Drilled By - R.rs stet, Address' w NY .1 Q5Q9 Buildmg,.TYPe !Tame, Y Four: 4 15 74:- . No- of Bedrooms 'Date Permit Issued Mons Rc�' d Has Erosion Control Been' Completetl� r "= I certify that thesystem(s) as listed`seniing the above.premi3es were constructed .essentially as shown on'the plans of the:`completed work. (cop�es_of which are. I attached), and iri accordance with the standards rules and,regulatio�s plan's fil and the permit .issued by p- utnam County 'Department of Health. duns 3, 1974 Date Certified P,E X R P: '6', Cp.. 53 Garme1, NY 1Q51 292Q6 Address^ License No: „ :. Any .person ,occupying premises served by the ,above systems) shall`,promptly "take such act�on;as may be necessary to secure the`correct�on Hof any unsanitary congitions resulting from`,auch usage: Approval, of. •the separate, sewerage; system shall become null and void ias soon, as,- a'- public 'sanitary sewer becomes', - <� available and'the:'approval,;of the private.water'supply shall become n II.and. void when a.,- I water supply becomes 'available. --Such :approvals are.. subiect to motlification `or change .when, ,in the judgment of the Commissioner of HealLh,° -such revocafion;'modifiication ,or ,change is necessary. _t ply /74 Date B Y Tit le 6l a 0 Robenat Contractors Inc. Owner or PurcHaser of Building Owner Building Constructed by Birch Hill Rd. Location - Street Frame Building Type Patterson Municipality Section Block 3 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 wi ul or negli nt act of the occupant of the building utilizing the sy to . Dated this 1st day f Ma 1 74 Si nature , fi, �' y Y 9 g �� Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.7,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 /® ,f (. WFLL COMPLE -f' 10—'U. REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 Division of Environmental Health Services 1 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 I• 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 COMPLETIQN OWNER NAME Gen,-. Radar ADDRESS Put.na,,m Valle-v- N--w York LOCATION OF WELL (No. 6 Street) (Town) (Lot Numbor) 3irch Hill Road. Patterson, . TT.,V,Y. PROPOSED USE OF WELL BUSINESS t---'%J DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL F1 SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) (S DRILLING EQUIPMENT �� ROTARY � ACOMPRESSED CABLE IR PERCUSSION ❑ PERCUSSION OTHER � ❑ (Specify) CASING DETAILS LENGTH (feet) 1.57 DIAMETER (inches) l 5 _ WEIGHT PER FOOT 17 V [ _'.i THREADED ❑ WELDED DRIVE SHOE YES. 17 NO WAS OYES CMG .t 7 O YES L=} NO YIELD TEST HOURS G.P.M. FYI ❑ BAILED ❑ PUMPED COMPRESSED AIR I ii. 12 YIELD (G.P.M.) 12 WATER LEVEL MEASURE FROM LAND SURFACE - STATIC (Specify feet) DURING YIELD TEST reef) 320 Depth of Completed Well in feet below Land surface: 0 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMErER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (leer) TO (feet) DEPTH FROM LAND SURFACEI FORMATION DESCRIPTION Sketch exact location of well with, distances, to at least two permanent landmarks. . FEFT 4� FEFT 0 152 Cray haraPan and bo�.lars, it 152 320 Med.i.Um herd frranite. i ii 'I I� ® . I If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE /3 11 r&Z 1 DATE WELL COMPLETED !1 �... / / 7 OAT O REPORT 11 °7 �vELL GRILLER (Signature) _ _ , F re s . d.e r.t . f Robenat Contractors Inc. Owner or Pure aser o Building Owner Building Constructed by rz Location - Street Patterson Municipality. Section r Block Frame 3 Building Type 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 day ofd 'lam 19W Signat �re Title, I Corp ration, give n, e 7nd Zcd,, d re s s T - - - - - - - - - --- - - - _. - - - - - - - - � - _. THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLAN 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 O� a BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 3065 SOURCE: Gene Radar - new well .birch Hill :toad Patterson, N.Y. COLLECTED: Oct. 5 , 1973 BY: 11 i 1 Z Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Oct. 16, 1973 0 per 100 ml. O Roy— ickwit P. E. Director 7— -,!,�.'VUTNAM v OUNn a DEPh RT-MENT -''OF-'�,liEALT14Division of Enonme eWServlcm Caimil. _!'iO5I2:_.. -,-, _l66hStIWCTION PERMIT FOR SEWAGE .DISPOSAL SYSTEM. Patterson Town or vil'lage7. 8'1 mh -:H il I 'Ad.; Located at section t 1 336'�" t" ' 'Subdivision Lot jo kd' -P r s—I ­Robon`6 t" C" �'t` nc. Owner— Oscawana> Lake` A dress 7 --- tfi"Mf Val ley, Building Type' F rbrlie Lot Area J Acre Three IDO on 1" J Number of Bedrooms total Habitable -Space Feet Square Fe Septic tank :ic i nich, width trencti neal,*f Separate bparate Sewerage ;System to consist , I . o f .1000. Gal. `66 iet 3 6 Paul Lond"I I UPatterson;` _ To be constructed by Address Water Supply: Public, S ppjy From Private _31 i ,!y *to be by Address-: 6 png"� Other Requirements ­ I 'represent that.1 am wholly and completely responsible for-the design and loca on, of the ,proposed m,4ysti"(i), 1j that the separate a sewage disposal. system above described will be con structe-0, -as, shown on theapprov6d amendment there to'and. ln�accor6i-nce with the staficlards, rules and re.gula' ;,Ons ot t1ne, .Putnam'. t '6f Health, and hit on' - completion thereof a _.lOkiflcite� -of- Conitiucti'�h Compliance" i .County Department Aha com ell satisfactory to the4 6 in m 'loner of Healthwill b6 sub itted to the Department, and a.written guarantee Will condition . - be J u, ,rRis hedthe owner,his. Wc PS s sorsi-hei rsor assigns, er,4 h at A s i builder . r will place in good operating ah ' -part of said sewage disposal-system during the period of 'tWo"(2). years immediately g ithe d ate.of th e'issu- . ante of the approval of the -Certifcatebf -Construction - Compliance tfie-original system or thereto; 2) that thie::d_rhle� -well 'described'above M Will be located as shown on the a, and- that said well will 6' install_ ' ' I- j. in accordance - -the' staliftr s., rules and rec_uTaM`onv of the, Putnam pproved.plan d I C6unty Depariment-.6f, 1­16ith. 7 9/' R'A bite 1.3 X p 35 �GOJn 0 At"" 10512`1 2920 c 'h ress Li e ge.'No. APPROVED FOR CONSTRUCTION This appr'9yal.expires'one yeair -from -the date issued unless ­construction of,the building fi"'b'een, undertaken and is: revocable for cause or.may of construction 'Pe4rridn'cidd-dr.-modified when -"f Health. -A6jF,.Ehan -a" 0 ge`bI altirition i requires A new ermtt.. A r disposal .of domestic sa So' e,-' te.. �ly- ppr64ed.fo Date By REVIEW CILF;CK SMT DOCIM,NTS Meets Std.! Remarks I%es ; No y House plans 0. K. Design data sheet i Peres presoaked? Min. t 30" pert test depth Const. results for 3 runs i D. Hole log 0. K. i Corporate Affidavit for other tin individual Authorization. for .engineer _ ! Letter from Water Supply if applicable If variance requested -such noted on plans & apps._ _c;iLte DETAILS to P. L. 20' _ if change is proposed.,) Foundation walls 100' to Existing contours shown show new contours) ! �° to stream, march, lake, etc. L Slopes for driveway cuts, etc. shown V _ ! Ntiater service line location !Ail A j to Footing.. drain, etc. location 10' to large trees Top slope, bottom slope of fill ! + ! ! Percolation tests and deep test pit location j ! Septic tank size and conformance to std.- I 3 E.R. house minimum House setback shown I �� • - __! = _. 1. .. -_ n.L .,. l .( ...� .L All wd"e -o v i..l•Ililli 5v f''. ()Jl C'-U 'iLwW�.L Plan and profile SDS I A-11 other wells and SDS closer 200 I shown or reference made � , Property boundaries (metes and bounds - clearly shown)' r _ SEPARATION DISTANCE'S SPECIFIED ON PL" 10' to P. L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. L 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 0' X15' from foundation to septic tank to pipe from leader drain & f 6 .expansion): I/ I f . -b FIELD CHECK LIST Date: fix Ins p. by: LZ .INITIAL SITE INSPECTION Yes No Comme ts. Property lines or corners found . . . . . . . .. Can estimate house location . . . . . . . __�� .. Will driveway need cut • . • • . • • . • • •. Must trees be removed -note these . Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . . . Sufficient SDS area available considering driveway cut,house location,separation . distances, etc. DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description:. fy: + -y C. -T� Date: -- FINAL SITE INSPECTION- Insp• by: House located where shown on approved plan SIDS l.nnat.'Arl T.ThAre approved Width of trench average` Slope of the line and trench. acceptable Room allowed for expansion trenches . • . . Over 50 ft. from swamp,watercourse , ^ - Natural soil not stripped or SDS area unnecessarily graded . . . . . . 10 Ft. maintained from prop.line and 20 ft. from house . . Separation of trench from house, well etc. follows plan . . . . . . . . . . _ Number of bedrooms checks Stones, brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . . . . 15 Ft. of peripheral soil horizontally from trench. . . . . . . . . . . . ... _ Junction boxes properly set Could surface run off from driveway, roads, ground surface, etc. channel near SDS o area .. . . Does lot drainage appear C.K. in area of SDS. FINAL GRADING OF SITE ACCEPTABLE ...,p 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 Ico,�e.,a Co.,�ro�►r3Address ,C3ii -c� /Ti�/ /e4' Located at (Street. 2 L Sec. Block Lot InUlcate cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Rim Elapse 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 1 11010 /fir 2/ 9 3 / /¢�3 9 _ 14- 4 5 � 1 2 5 Notes: 1) Teats 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. DEPTH G. L. 6" 12" 18" 24" 30" 36" 42" 48" 5411 60" 66" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED ° IN TEST HOLF HOLE NO._ HOLE N0. -"\ 7211 7811 8411 INDICATE =ft A ;,t CH GROUND WATER IS ENCOUNTERED Move ,INDICATE LEVEL TO RICH W TER LEVEL RISES AFTER BEING ENCOUNTERED Alb -P& . TESTS MADE BY Xpt. t 7 6%!9 ' Date,2 61 DESIGN Soil Rate Used &46 Min/l "Drop: S.D. Usable Area Provided D ' No. of Bedrooms r &!*e Septic Tank Capacity. 1,0,eo Gals.' Type Ri soya Absorption Area Provided By roo L.F. x2411. 5b width trench. � Other — / Ja %P- Address R.D. 6; Box 353 Fry N, PR f,� •., O, Camel, New York 10512 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: G Soil Rate Approved Sq. Ft /Cal. Ch Date F�si N Of 0, . 2920 � pE OPTNE ST UTNAM COUNTY DEPARTMENT OF HEALTH i :. ;Division of Environmental.' io th Services l,arMe/ N Y _10512 �. x CONSTRU"di6 � PERMIT FOR SEWAGE DISPOSAL SYSTEM, Town or: Village l Located at 11 _Rd Section Block Subdivision at .1n336 got 3 yob Owner kobenat Contractors .Inc Add ►e55 % E A Rader Oscawana.Lake: Rd Building Frame Lo't Area 1+ Acr e Putnam 11x1 hey, NY = Type r Number of .Bedrooms -FO.ur Total Habitabylii Space 1X08 011; 1 11 F1 Souare .Feet 1250 , 40.0 36 inch Separate Sewerage System : -to consist of Gal Sept,c Tank lineal feet .X width trench ' °Paul Lundel f u Address tterson NY To be constructed. by °' , P . Water Supply: Public Supply From V is ^ Private Supply, to be drilled by Address - Other .:Requirements No ne. i�� represent that I am. wholly and completely responsible for the design.antl, location of the proposed skem(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 regu axons o the u am County Department of ` Health," and; that on completion thereof a "Certificate of .Construction Compliance?,*. 'satisfactory to the Commissioner of Health Will' be, submitted to the.Department .;and a' written, guarantee will be fur"nisned the owner his,wccessors heirs or assigns' "by the`bwlder °;that said builder: will. place in good operating condition any part of said sewage disposal system during'the period of, two (2)'.years mmedlately following the date of the,'issu ante of the approval of ahe Certificate of ConstrucUOn Compliance of ahe original system or any _repairs thereto 2).'that the drilleil?we14 described ,above , Will be located asshown on the approvedplan and that said well will be installed �n accortlan a with the stantlartls, rules and regulations of the •Putnam: County Department of Health f V Date 48/74 (R2V `'9/n/7 �: Signed E ^ R A Address R D 6 , Box 353 _. License No 29206``1 fiPPROVED,f O.R.CONSTRUCTION Tliis'.approVal, expires` eye from a issued .unless constructioh of the: building has been undertakenrand is ; revocable fog cause or may men modified when' onside :necessary by _ Corn f Health -Any' change ' or - alteration of construction requires a. tie per t. ' Approveed for disposal of do ' e ndary sewage ry e upply only f IP Date Title ' + _ .. _. 2 t - - 11- a t , X r x" — . , , � , .. . , r S t - I, ' f �,,, y M J S A' ' :' , t i Jv 4, S „{ ST 0 i. a ... ,� r - ;'...� t Y`-' jr 5, ; dJ t � i - �a� t A .. p y 6{JV t3s s. �( �t, ,1 Y W ...•,fi n G i- rit5a�� tJ a f v %v !a, i K St 's l t� tylt' E to a. tF Y eb k, 4 Y A_. .. y.. J d 'v - J :� �\ - 41 l .,3 V� rY = � �' S V 3 } r r 'll X 1 tip: u `' ^.. - i� " "• .- t N �l . - I.," } } - / . . . ;— '. — — .I - k, i ' ' I " b " t S S p *. � � , �E'rcAPojky r T k i s.f^ i' t t J -� `��? Y Y -ry,�� •. • • T Z. , y t J J am. ,tf ! 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X.:. %, t: cf V a, -a e . �•.t ..._ . y�t�• 1• 5, r +�b iii y��+i �.�_F /` 1 1} �. .. \. 1-•_ D SO a % `� "e�RFO Rp r -' - 11 I' t �x f _",,s_It x "! Y+, Y dC k 'y '+ r ¢ 4 Y \ E i�i r i '-y` ^i. S'•t M t >: f � cr' -,R �. h, i x 45.. Y r f �. 5. ''!';9i rC ti E r M JS t} Y k 4 i. '� "Cti( 'i 's Y" { _.�-f' f!a' +•"` - +1 a J t -.••Z, h r. � ;: < " ., `. . A' r te!.. ,+� _r :t 11. x it ! y+ r 3 n. i• 9 '. s• "4� "`°'ms,,µ 1 irk r } -1 I ,sr ': _ a Y ° s' .. , t t- 8,�i, s :' LVF j"+� . S " ...�i 14+o'�'t.F 1 iy }' t 6Jp' rL +tb f A 7 t ry,.t, r }d 45`Y.- 9 S F. i r� �, , . w.,x�+Afyaw z ... ..r ..L., 4� t s u' `dya u i� d t *,� . _ _gym ,L �_ I' t �x f _",,s_It x "! Y+, Y dC k 'y '+ r ¢ 4 Y \ E i�i r i '-y` ^i. S'•t M t >: f � cr' -,R �. h, i x 45.. Y r f �. 5. ''!';9i rC ti E r M JS t} Y k 4 i. '� "Cti( 'i 's Y" { _.�-f' f!a' +•"` - +1 a J t -.••Z, h r. � ;: < " ., `. . A' r te!.. ,+� _r :t 11. x it ! y+ r 3 n. i• 9 '. s• "4� "`°'ms,,µ 1 irk r } -1 I ,sr ': _ a Y ° s' .. , t t- 8,�i, s :' LVF j"+� . S " ...�i 14+o'�'t.F 1 iy }' t 6Jp' rL +tb f A 7 t ry,.t, r }d 45`Y.- 9 S F. i r� �, , . w.,x�+Afyaw z ... ..r ..L., 4� t s u' `dya u i� d t *,� . _ _gym ,L �_ L-4.- ►PPROVEE) JUN .4 1974. Structure located from survey by sur6yor noted fielo wM Well located by: Surveyors survey._ ❑- Vgplilllp e report Engineers mesurements.0— Tank, boxes, pits, galleries 8 Jlat irals lo•cole.d by.:Controctoirr. Healthd4t-. Field inspection by: Health dept do t e:-,;. Eng4neer dote NOTES: 1) Li 0 DIMENSIONS A 8 A D 9 D A E 8 E 2--?� L k A F "IF A Q ---7=-- -8 'G A H .ow, LOCATION Street - _L Taw. ri:L\-; -Z r--#E-;X-5 s=ue -C OUntY: tote SQ8`jD.IVI'S ION M 0 -- L--3 -� . Block,._ LOT Ns_ 3 udder: _L Z- _Qz Surveyor- 2.:6 C �c't —F D Job Scale Dro.ion�� JOHN H, PRE -S -S. .PE CONSULTING ENGINEER RD 6 Box 353 t.ARME.L NY 10512 -(8141 876- 6170.