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HomeMy WebLinkAbout0344DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -46 BOX 4 r0 JL M Ame hi .` r �Y ` r6, dIrm 00153 I R is�g� SITE LOCATION Baldwin Rd, T1$ 11 Block #4 MAILING ADDRESS Patterson, NY. PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE 4-17 -88 TYPE FACILITY Single Family dwelling PROPOSED INSTALLER J .P .NILSEN EXCAVATING PHONE 225 -0521 Proposal (include sketch locating all adjacent wells): NOTE: 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. System to be installed in same area as existing system with same footage. F Proposal approved Proposal Disapproved Inspector's SighaturejkAlMe !roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. i SIGNATURE TITLE () � a �,� DATE D PIES: Vbite (PAD); Ye]1cw (Ttkn ffi); Pink (Anpliamt) Proposal Page No. of Pages J. P. NILSEN EXCAVATING RD 6 Bullet Hole Rd. CARMEL, NEW YORK 10512 (914) 225 -0521 PROPOSAL SUBMITTED TO PHONE DATE r S/ /Z"q TREE l JOB NAME � ? /V R.C11- CITY, STATE A. D ZIP CODE / JOB LOCATION ARCHITECT DATE of PLANS lJOB PHONE We hereby submit specifications and estimates for: ...................... _......._..._ ......................... ...................................................................................................................... _......,.............................. ........................., ......... ..,............................................................... ............... .......... ......... ............ .......... .. ..._........ �• .......... ... ........... ............ .., ........ ......., .......... ... .. i LLJ ........... ......................._ ....C................ /I .......... .................................................... ...... ................._-_....... ...... .._.................... .............................a. ........... .......fJ......�....•........._ ....................... .... ............ ......5�... ........... 3S' .................. � .............. ..............................+ ................. ......... ............................................. .......................... �± C ......................... `..................................................... ........... . ... ....._Gf ..... _. 3� .. .................. ........................... ............................................................... ._............ . ................... . . . . . . .. .. .. .... . . .. . . .. . . . . .. . . .......... .......... ....... . . . . ... ...... ...... . . ..... . . . ............. . ................ . .. . . ... . .. ... . . . . . .... . . .. .... ..... . .... .............. . . . . . . . .. . . . .. . . .. . . .. .. ................. . . . ... .... .. ....................................................................................... . . . . .. . . .. . . .. . . . . . . . .. . . . . . . . ..... . . . . ... . . . . . .. .. . . . .. . . . . .. . .. . . . . . . . . . .. . . .... . . . . . .. . .. . .... ............................... .. . ... .... . ..... .......... . ........................... . .......................................................................................................... ............................... ........... Me proV119f hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: to be made as follows: dollars ($ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifica• Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within Arrpptatur of Fropood —The above prices, specifications .and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature days. i A 00 Af 0 boo BLOC: -: t LOCG?O - J�?' °cv bt.i_� Lo l �® ®+►ice AW1 i A0 -4o ov vi - -- -- ^ ~— - - ^- - -- - _ - - - - - Y AWAbF Ye zi -'!D. 44+16h�lql County Department of Health Division of Environmental Sanitation This report is to be completed by well driller and submitted to Health Department, together with laboratory report of analysis of water sample indicating water is of satisfactory-bacterial quality, before certificate of construction- compliance is issuede Well construction to be in accordance with Bulletin SD-62 DRULES & REGULATICKS RELATING TO INDIVIDUAL WATER SUPPLIES" Baldwin Road WELL #5872 LOCATION: MUNICIPALITY Patterson , ..N.Y. SECTICK BLOCK IA WELL ON=*- Paulson Builders, Hill & Dale Road, Carmel, New York Nam Street Address City and Tom WELL DBILLM P. F. BEAL & SONS,, INC. BREWSTER, NEW YORE Lenkths 80 Feet ° or t g Pam 6 Hourst3tatics 22 Feet Makes Diameters h Inches gields 15 G.PoM„ f or Pumued Pest t Lm dh Ft� lSize I t a Kinds Heavy duty _ seamless steel tubinE ° r Diameter TOTAL DEPTH OF WELL 160 1 FEET . Depth From Ground Surface r ° Give description of Formations penetrated, such as: peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diamete: ° and sand (fine, medium, coarse), color of material, structure (Loose, packed, t cemented, soft, hard). For examples 0 ft. to 27 ft. fine, packed, yellow sand; - ° 27 ft. to 134 fts gray granite. ° e _0Ft.to 7o Ft. t Drilling in overburden (clay and boulders) Ft.to Ft. ° Hit moo n+ 20 fAe t• 7OFt,to 80 Ft ®t Drilling in rock (set casing - grouted) 80 Ftoto 160 pte t t Drilling in �o solid rock (limestone) ° —_ Ftoto Ft. ° t ___Ft jto_ _ Ft. E e Ft•to Ft. ° ,Ft °to Ft. ° &te Well Was Completed April 15, 1971 Date of1Repor 1971 Well Sienatur® � BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. WATER ANALYSIS REPORT SAMPLE NO. 2361 SOURCE: William Muller - faucet - well supply Baldwin Road Patterson, N.Y, COLLECTED: June 21, 1971 BY: Roy Paulson BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when thl sample was collected. June 23, 1971 6 0 per 100 ml. Roy Bickwit P. E. Director PUTNAM COUNTY DEPARTMENT OF HEALTH. �a . �. F Division `of ,Environmental Healtti. Services . Carir►el 4N Y 10512 G(Y%S.✓ Q/o� �% OIL ccnJ�i en1�i`rt�' d�S oScc'j Q v=�cL i I represent that l am wholly and completely responsible for 'the design and aocation of'the. proposed system(s),;r.1) that *'t`he. separate sewage disposal .systerh above described will be constructedas shown on the approved 'amendment there. -to and,in accordance with the'standards, rules an ;regulations o e Putnam .I County Department` of.. - Health, and thaE,on,completionthereof a;!�Gertificate of,Construction Compliance " >satisfactor -y to tfie: Commissioner of Health will be submitted'to the Department;` and a written guarantee w�IL'be "furnished the,. owner; his successors, heirs`or assigns by the: builder.; _that said - ,builder will place 1.in good .operating condition. any .part of. said sewage disposal "system during; the period of two (2) years immediately ;fol low ing- the date.bf the -issu- ail'ce Wthe agiproval -of the Certificate of Construction ;Compliance of,the original system.or any repairs thereto 2jTt at the drilled well described above • ,_ .: - ,- ,wall be.locatetlrasshanrh qn the approved plan and:fhat saidiwell will`be installed' in accordance' with•ahe standards, rules antl 'regula i—Tons of "the' Putnam County, Department of H alth Date [� 5�9nedn P E R A a Address t License No. APPROVED FOR CONSTRUCTION This approval expires one,yea the date---issued unless construclion+ the --bullding ihas been undertaken, and As ,revocable for `cause.or may' be-amended.or':modif,ied when considere essary by .the Commissioner of Health. Any changq_ or alteration of construction 111- - requires, a new ,p rMit Approved for disposal of domestic sa sewag ' to r supply only ±r . ` , Date By-- Title K l CONSTRUCTION PERMIT FOR SEWAGE_ DISPOSAL SYSTEMg��� -5�, a frown or-, village ' r` located at ���t�i'_ Section Block r/"sf'�•�, Su 6�ryr - 'r'<��T�� —�4P�p ' Lot Job AV. s � AV. Address � Building Lot Area �_ -- Ai .Type —sM- ! ' ° Number 'of Bedrooms °Q %r1 " ' - - Total - Habitable Space' ,p �/��� d6J �~$quare ,Feet Separate Sewerage System to ,consist of ®� Gal Septic Tank- y / lineal feet X y width trench < To be, constructed -by, Address ;Vater Supp ly: Public - Supply From 11 _,�P.rivate"Supply, ��to t e drilled by � Ll k` - I Address G(Y%S.✓ Q/o� �% OIL ccnJ�i en1�i`rt�' d�S oScc'j Q v=�cL i I represent that l am wholly and completely responsible for 'the design and aocation of'the. proposed system(s),;r.1) that *'t`he. separate sewage disposal .systerh above described will be constructedas shown on the approved 'amendment there. -to and,in accordance with the'standards, rules an ;regulations o e Putnam .I County Department` of.. - Health, and thaE,on,completionthereof a;!�Gertificate of,Construction Compliance " >satisfactor -y to tfie: Commissioner of Health will be submitted'to the Department;` and a written guarantee w�IL'be "furnished the,. owner; his successors, heirs`or assigns by the: builder.; _that said - ,builder will place 1.in good .operating condition. any .part of. said sewage disposal "system during; the period of two (2) years immediately ;fol low ing- the date.bf the -issu- ail'ce Wthe agiproval -of the Certificate of Construction ;Compliance of,the original system.or any repairs thereto 2jTt at the drilled well described above • ,_ .: - ,- ,wall be.locatetlrasshanrh qn the approved plan and:fhat saidiwell will`be installed' in accordance' with•ahe standards, rules antl 'regula i—Tons of "the' Putnam County, Department of H alth Date [� 5�9nedn P E R A a Address t License No. APPROVED FOR CONSTRUCTION This approval expires one,yea the date---issued unless construclion+ the --bullding ihas been undertaken, and As ,revocable for `cause.or may' be-amended.or':modif,ied when considere essary by .the Commissioner of Health. Any changq_ or alteration of construction 111- - requires, a new ,p rMit Approved for disposal of domestic sa sewag ' to r supply only ±r . ` , Date By-- Title K l PUT \'AM COUNTY DEPART% 'T OF H&:`LTH DIVISION OF ENVIRO`r`TAL HEALTH' SERVICES DESIGN DATA SHEET - SEPARATE SEtvAGE DISPOSAL SYSTELI FILE NO. Owner a k& i�tt I1�p Address �a►�' k�iy Located at (Street)_ / 0ont �� . Block_ Lot (Indicate nearest cross street) Municipality_ ���P.rsQr� Watershed CirD�vr ..SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION Hole Number CLOCK TIME , PERCOLATION PERCOLATION Run No. Start Stop Elapse Time Min. Depth to tdater From: Ground Surface Start Stop Inches Inches Water Level in Inches Drop in Inches Soil Rate Min/in. drop 2 4 Le 5 lid 7 1 2 3 4 1 2 3 - 4 . n 5 V Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are ob- tained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be-made from top of hole. TEST PIT DATA REQUIRED C0 BE SUBMITTED IN'ITH APPLICATION' DESCRIPTION�OF SOILS ENCOUNTERED I\ TEST HOLES DEPTH HOLE NO ,HOLE NO. HOLE NO._ G.L. Err 12 rT is ;r _ . 2 41r 3 0'r 36" 42'r 48 -ft e✓ f9( 5411 6o,. 667t 72 ;. .78T Y9"w r 8 Orr " '% ^ — Aoo LC Or INDICATE LEVEL AT WHICH GROUND WATER IUNTERED � INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEI\' (fENCOUNTERED TESTS NUDE BY / ��� -.y��/ .. /� at/ia ti. Soil Rate Used__/4 Min /1'r Drop: S.D. Usable Area Provided_,, d"0 /1f, No. of Bedrooms _Septic Tank Capacity !?eje)_Gals. Type Absorption Area Provided . By 231 L. F..,,24!- 36" &,00 width trench. Other Name Address X1. B 44-4 PUTNAM COUNTY DEPARTKLNT. OF HEALTH Soil Rate Approved Sq. Ft. /Gal. Checked b %, `: Date SITE LOCH OWNER'S MAILING i PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY i�_'7�_� PERSON INTERVIEWED C7 [.t/ Al✓ Lr.� PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. DATE Ste/ l / d �% TYPE FACILITY % �S /'6 -0 +-1 PROPOSED INSTALLER <' i Gr A 4,,-r7 PHONE 8 YS~- Z 7 % ° f S-a ADDRESS ,'�- f A 2 & f ,,N REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: 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. I, as owner, o eported age of owner agree to the conditions stated on this form. SIGNA TITLE a CAJ A/ �� DATE —4 / Z O . �` Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. 1)rnr.rool �srrwo� 4 Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML X/Z TE .� J.D. C - _ FM f., 1� F4 WIN • :k5 V cv, Awn -2z rtxc-c"-r M+ v TE:&-v IAOL-m i-o ar- . . . . . . r- C73, 4y T.