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HomeMy WebLinkAbout085.20-01-35.120 • -41 731 473Z CORTLAND COUNTY HEALTH DEPARTMENT CROSS CONNECTION CONTROL ENGINEERING REPORT 1. Describe the water usage in the proposed facility. Pleas include all hazardous and aesthetically objectionable substances that may be in danger of cross connection. t2_1NKtr.1C um, r €,1cl A a.),o 77 G-,C:.�"' , 2. Size and description of all fire and domestic water services. Sy 2 'o 1 L IS Pal N o( Go N t c-T a.C3 C7 7c1(S E_.t �. (A.'ti 1 i i— 3e t'1 P�1 U l�'�E Uv ti .. A N 14.: A I i . ice..)Ee t We i 71:4 vas i re So L. 3. Number of floors in the facility. 4. Actual or estimated maximum flow demand. 5. Pressure—Existing: l c 5 After installation: 6. Class of sprinkler system: Description of the firefighting system: Z-t3 1-4-/i b f..A=, n.r f Fan ' o f 7. Description of the installation-lighting,heating, drainage, etc... A .A-re,c) i C/!^ �A (H r .^o $ L icp.) t 8. Are booster pumps in use? 1.10 If Yes, is the pressure adequate on the suction side: At the highest and furthest fixture: What is the cutoff switch set at? PSI 9. Does the system need a continuous water supply(Dual Backflow Preventers): 0/0 10. Elevation of the 100 year flood plain: 11. Are there any existing devices in this facility? rJ If Yes, Where? Please Submit This Form Along With The Following: • Site Plan • Plumbing Floor Plan • Vertical Cross Section Plan selected • Application For Approval of Backflow Prevention Devices Rcv.5R004 f v L gLly- go 2 1 1 ilapo w' t,ouk-S • NEW YORK STATE DEPARTMENT OF HEALTH Application For Approval of Bureau of Public Water Supply Prolection Bac.kflow Prevention Devices PRINT OR TYPE ALL ENTRIES EXCEPT SIGNATURES Block e I Lot# FOR DEPARTMENT USE ONLY Please complete items 1 through 12a+Block and Lot Numbers Log No. 1.Name of Facility 2.City.Village,Town 3.County DF.F1l G 60 f too 1n Gart<i r Ar\1,11JrLLE:: )0-7 f.-Q0,14 t tree 4.Location of Facility s -city slate zip 3, `5 / P, -7 (_'i ,r_ Q.� r ��: .� 0^� t �' 4a.Phone N&imbers - Contact Person I u &o7 84-4 - ?Ds 1 _ Fri--a,0 KP-A 'F _ 5.Approx.Location of Device(s) 16.Mfg.Model#(��eS ,Size of Devices) #of Fire Services #of Domestic Services of Combined Services Total#of Services Total#of Buildings 7.Name of Owner I Title Phone Number 8.Nature of works ift..'�ti J K2 A t^ Cy.) r.)Ea_. 0 -7 ,-.9,-,-4 u 7 L t siK Initial Device Installation Full Mailing street p Replace Existing Device Address 9, 0, &O.4 'I.::::-.5(„„ 8a. New:Service mot' state zip � U Existing Service _'n U. `�')G f� (.1)Jr3 .:'3 • 8b. 1 3 New Budding Owners Signature( -7�-' '"`` Date m d y Existing Building •,-r �` r O Major Renovation 9. Name of Design Engineer or Architect 10.NYS License# r ut tt'Eiy street /. Address • `ES R. FFi.C� (� PE D RA 0 Other s. citY •>' 1 Da.Telephone Number(s) C� scee by • 1` �. r . �� R�` 55520 . WI / P �� r OFESSION:^\ t cl Date 1 / / sign Original Ink signature and seal required on all copies, m d y 1 11.Water Systemte Pressure(psi)at Point of Connection 12.Estimate Installation Cost 12a. Estimate Design Cost Max r?O , Avg 7 c Min 56--- 14 A ^)4 13.Degree of List of processes or reasons that lead to degree of hazard checked: Hazard 0 Hazardous • (l Aesthetically Objectionable 14.Public water supply name a of suppliers designed repr sentative 00 16 t_ N,.\\t �OkeTN i c. krx • 1 c f\\ atlec t Mailing address y"- street 3 5-7 7 'Tar G-c t y�8 •liu ��k ,- �ty stare z. G10 ��f_ ) 3CLlj m d y Signaiur 'C/" o^.1 / 11 r ts) Telephone No. ((0i.)7 ) -.S"--(0. 5)L3-7 t •Your signature endorses proposal Date Note: All applications must be accompanied by plans,specifications and an engineer's report describing the project in detail.The project must first be submitted to the water supplier,who will forward it to the local public health engineer.This form must be prepared in quadruplicate with four copies of all plans,specifications and descriptive literature. 2 SY-�- 5 R. F �0� + - lf, L To BE t., ,m • t", w AND UNOISS RUCTED FROka ,:_ DEVICE TO THE COLAP WATER WAIN 't..9 - °• ss52a - N- .4�0FESSID;iAN `` ti oases 3/4•CU. i4ER SFFLT Ik) ." 1 .}- FLOW • LEL I ' But_VALVE B+LL (TYP-) ‘ntvE 3 NOTE WrJNr><w a" Wni rN BACK Iwo STR £R 30- Lunt_ cv FRONT OF DEVICE U FOR L A IDI 1NC£ AND TESTING PRESSURE ZONE BAO:flow PREVENTER X 'PLAN C— PLAN VIEW NTS_ • 3/-BAC FLLX PRBE7IIEE*/S7R.N5t 1K ER Va-r5"HOOFL{0a4-47h5 RIMMED ti PKISU E 2L E TYPE OR AAPRIMED EF3K A\J /- S BILL w4.3.E (TYP) a .yii. ps'C you're > ON) %%%- ?i ... •I I z .►.❖•.! , •4* 11 i EOO • •••Ar i I. / R •-••:•••• 1 DRADt ♦•••n• ..� i _ F e _ r-; `` --II--- Do _ - a' ` C DCSTC. L S TARY (OUT) J PLAN C— ELEVATION N.T.E. PLAN SELECTED PLAN A [ ] PLAN B [ ] PLAN C [ ✓ OTHER N QT S-'f FA-" Rev.5/2004 5 13, FL L I Qe.V6Pfi 0 N) aVIGe �A.) w ATE t2- L , _____________ _ 11‘.- ....--.. ...,,. .- 1. 1, ar o • •• NEW OFFICE '"OFFICE ''OFFICE 24. e�. ia. ,. NEW A IVE R .:I,ii p:.: eee Lrcp " `III\fI- ''e Eo.I Dr..Inq es a ° a FILE ROOM a EXIST. • u gee L r Detail " WALK-IN ^8 u o- e• n.".... COOLER r�i.a... r..w.i r r j"'\ ee iYirilhi a e • . / ..r II ll .v IlTTJ CE 1I �� • E : I_- ' ,6 LARGE LAB u a w�;,y r'„. •e NEW CONFERENCE n.�«y•v • MECH. ...Wt.: -- - W ITSE.I. .1 EXIT w .e m, �� RM. .....,le...rr.— `fir p' a �� •',v• e ° ° II 9 •0 e TREE CLIMBER'S O _' +5 �J� o.r o• n. ,......,.... ., III�l� -E551NG ROOM F. .J w.... See Lat.Scale ������ OFFICE Dreulnq e e MI: `'-'-• •�...-1 rt: r...,a... tee'...., y AT STORAGE v e v c.o sv ^ II _'9 i.0 ° k .1 IOW .MEN EN TOIL_ RECEPTION ° c • ..:a ma OFFICE TOIL. e"••.�i.Z" OFFICE ° OFFICE u• EXITSTORAGE�..... 411111111 ocrc • (� '� ne:�.: MAIM "IN ..•�� "Y 0. .,a ".. e - Nw b KW N.l GM ,r e...ue tu. .,..w.... •..�..... / See Large Det,Il DWq. Em.rgarcy x..eby SEE LARGE DETAIL - NOTES: -' New Storage Area veers.:On cork. �. P. RN DRAWINGS -VEST.--�n.,,....,, Nw C.p.l Tliac Ta R.l.c. 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N.Y. 13053 A-2 PHONE/FAX (601)644-9021 DATEMey 0�•3013 SCALE AS NOTED Acc ► /� 1 , c 'f l"cpu`i l fL � t;1 1 1 af� p y>;>11c-� �S� U.9 AEnt. ,AiEnrg.cy Na Conn �„ G�PW N:Ge St y Men no•w Rack rn, In.r•Iw rn —p —� IF v t1 4 s'e' �' t EXIT NVSW �• 3y w s wo 3a R___R odelocated_N._yq�_I See Large Seale Drawing l S STORAGE s OFFICE OFFICE 4 OFFICE -• OFFICE OFFICE N yTl/ Lb.Poe To Support Dn.EI TII .e r �� tl = ,> NIPI FILES , //J a `N.Nab Tool R 7ack au Day L•Movable Floor To Unlny a.lec.0 Este.TNrro.•... t .... . .r: , PeN• U.ODu.sb rn, Sea Lager DraWtrq \ II/ v.wale Tr.e.rn _ ry tl 8 tl tl Transfer Staid, I Syu q =;<a p u 0 OFFICE For G o fn!e 'SE o a 0....NTo.. STOR. A A • 1?D...... R�JTILIET CLOD a Y New V((I) 1T Egnp.Boa .v Wa1I,Plywood C. • CellIg D / W41 Covering 'o r Cn°""' FILE ROOM • rn) f/ E"I•�Pa^e'B" ! CONFERENCE 1 A 1 4,Neu Reeves.Llgw. / D we PI Bvlp Abrv. On Diener• Ru MECH. 5TOR. w�cro"�:.;..mt •—.--------...____._.....-•iw•_._.TM a OFFICE ■ New AddlNoal 4Kb bblall BUI1.Un Bowe T) - OPIER/PHOTO ill Re•wn,,,° . e = ... La•- err f5B) uc Neu Ebc Outbu RU • 0 `Nee Dew In Areree"ii - ale Dreutn-uu•••••�•�a� ?� 0 STORAGE q op.nl,g rtu 1I xs DL,eall Do Bo.e MI 1 4. ID 3'-0'Door m/ ••� ii iii ! �.RRloe•u r':-,-.'``"-- Replace -.- ww SLICE Door. • V IyCr •�� `�'"'I�7i11 I '�1"To B.GIi.DInW LNi/ DL R.a. .wily r ow I'-0'OR.II A•Shaw a Neu Wall To Glling rn 1�3' •1•••••1•I ,■"' ' III '����'I a V On Ebb EM Or Bu IOI.g(Dp! (DB) (R.novblel ow ` , „' ■ as , Eµ Loch!TO O a s !�' t��"'�' "„",I!.• ��rLIBRARY mammon OFFICE "'ry z R.eev.aI EaNurg Remove Enrg.DFaue-h' �■ •l ••• w•i•- ..4=�' large Sul.Drewlnq ,b A V ��en•1=9 And Race•Ru •Cap Pb.eing!Tu '.�... p .TOIL.rl.. .. E�Er�_�I.D'nk Ru =���� •—p—Z L ll I rill►--'w o_• TOAn 14 See Lager Ch.ullq NMI Fern..Ces nl..�`r WESWEE•••i0e 1 ILIK1 ",..31m ° r I EXIT ? 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FLOOR FLAN DRAWN BY P.O.BOX 636 DRYDEN, N.Y. 13053 1 FLAN-- --_ DATEMej 07,2013 A_1 SCALE AS NOTED PHONE/FAX (601)644-5021 c c..i p 7 3Z,. r_ I . 4 V V Z D UNTY OF �'or,2z.e7,1/o i lie•O j eoN✓ -z99/7G/ 9n=r � . z� "SNO_t ,!�y � F 1p G/rt/z.S-a% .j�_>'2r° .� off' i' �/1oP0��/'l��� �05 3 f8 al k<o 4P /. 39, .E'.n. , N /eco O\ SS/ /Y ;;i -77 G h'oi' .::0. 5� ' nor, /RON V r /ZOO f r r1/:,V O UG�9L rY/U/7 i4;'-•7�'.-•nk�c. —X /%9p,2 4,e-'e-L ;� •:c ),eAlz•77�. �G�S..20'�—C/ —3S/ Z • �( D�.%S l� r4r.'.e riONOi ,c . /7/7C.eZ-,S 1 I �\ /�/7,j•- ����\,,, h� GL✓ ,RHiT c' ;e a)�� c�vaccd a .YG y:/38.7 ,e 5 7-,Y ,-1 ;"i'`l/GO/Nq. ri.. • / ---1 .38/7 /gay �0•a' J i'� -.— ys' S�/°- 'J /°re) sue/ _ '' N' LJG': ;Y.�i 1 n r _ L ...•'v ..i.:%Vins- 1 ( /9 � q� o' /, \\ f ,8G,9Cile O/ ,LA IL - - - J 4 s r , 1 j JJNO T R." '� 2.2 u 7=.1/STiNC C L�/yrG/Z�//,vim - --.5 �� DD r ,iCv Fj+Z 1-1�2AA /nova //Lon/ -2.i 2oU a.•it.' _w- _ .Z�O•Od/ atp � .�--�—L=7 anammom �z r--��. .D iZ.IO•d / — �' ' - Z Uf�E A2 /O/9Q ��� -.. /'// , Sfi/OC )//t/ 1 /A,VL25 OF zor 73 TOWN OF CORTLANDVILLE 3577 Terrace Road • Cortland, New York 13045 Phone: 607-756-9637 RESIDENTIAL OR COMMERCIAL APPLICATION [[ A ] Water I ] Sewer Account# - I Application for: Bill to: Fre a 4- ?ira 47L :1{. /� frredQ 14 h-'r-ci -- -1-- --I r- 3 1S— LrIk / e✓ I -L Po & ( �',&, I\ yder_ i\1 4 Phone: 19. 01 g h/4'* 021 Phone: be I g4 / 9O.q. To the Town of Cortlandville, New York: The undersi ned, being the 0 GO fC✓ of the property located at13_'J' L k e✓ R (Owner,Owners Agent) , does hereby request a permit to install a IA) ale ✓ service to serve (Water and/or Sewer) the___ ©in r i ��t said location. (Residence,Commercial The name and telephone of the per n or firm who will perform the above work: 01/1C For all new installations, plans and specifications for the proposed work are attached hereunto as EXHIBIT "A". In consideration of the granting of this permit,the undersigned agrees: (1) To accept and abide by all provisions of the Town of Cortlandville Water and Sewer ordinances and of all other ordinances or regulations that may be adopted in the future. (2) To maintain the sewer lateral from the building to the sewer main at no expense to the Town. (3) To maintain the water service from the curbbox to the building at no expense to the Town. (4) To notify this department when the water and/or sewer is ready for inspection,but before any portion of the work is covered. F CO (5) Notify this department 24 hours in advance for inspections.All inspections will be done ben the 1A of 7:30 a.m. and 3:00 p.m., Monday through Friday.Anyone that requires an inspection other tha ►ese hours, be charged for all overtime incurred by this department. 0 • \ PA Ib ^ C Kind of meter: I r e A I Meter fee: 04' �� Meter size: Water fee: 6 Q Meter No.: `7gl /3 to 'i 6 7 Sewer fee:Register Head No.: Reinspection fee: aq67 v 1) Tax Map#: 8 , AO-00'-3-6• !d./ Total: 6, - °u Signed: 72.--- i Date: 9 2 34 pplicant) Inspected by: Date: Check if meter picked up: White-Office Copy Yellow-Field Copy Pink-Customer Copy TOWN OF CORTLANDVILLE i-L- 5 3577 Terrace Road • Cortland, New York 13045 Phone: 607-756-9637 RESIDENTIAL OR COMMERCIAL APPLICATION [ X ]Water [ ] Sewer Account# %-.I Application for: 'lBill to: greS 4 ISru-1+' :I' . c,red d. 4ci cl- -Jr_ 3 $ /.S"— • kt t K r✓ fc, PO 601 t2 g 7 Lwydt.et- NV Phone: 6 a 7 AN (76021 Phone: 60 7 g i14/- 9 d k To the Town of Cortlandville,New York: The undersi ned,being the 0 GO n e✓ of the property located at,3� '/- 1- - 1-4 e✓ R 6 (Owner,Owners Agent) 11 , does hereby request a permit to install a IA) a k it service to serve the Cn m m P r D DOe f (Water and/or Sewer) said location. (Residence,Commercial The name and telephone of the per n or firm who will perform the above work: For all new installations,plans and specifications for the proposed work are attached hereunto as EXHIBIT "A". In consideration of the granting of this permit,the undersigned agrees: (1) To accept and abide by all provisions of the Town of Cortlandville Water and Sewer ordinances and of all other ordinances or regulations that may be adopted in the future. (2) To maintain the sewer lateral from the building to the sewer main at no expense to the Town. (3) To maintain the water service from the curbbox to the building at no expense to the Town. (4) To notify this department when the water and/or sewer is ready for inspection,but before any portion of the work is covered. (5) Notify this department 24 hours in advance for inspections.All inspections will be done between the hours of 7:30 a.m. and 3:00 p.m.,Monday through Friday.Anyone that requires an inspection other than these hours,will be charged for all overtime incurred by this department. e Kind of meter: i Pe R 1--. Meter fee: Meter size: Water fee: G0b6 Meter No.: 170.1 /3 iv 'U to 7 Sewer fee:Register Head No.: Reinspection fee: _0 D Tax Map#: 85, ,�1b-61'3.6• /c&J Total:oO Signed: PPlicant) Date: V/2 3//' - � Inspected by: �? Date: P--`�� ! Z Check if meter picked up: ❑ White-Office Copy % ow-Field Copy Pink-Customer Copy • TOWN OF CORTLANDVILLE WATER/ SEWER RECORD (OUTSIDE) STREET ADDRESS: 3815-3817 LUKER ROAD SANITARY SEWER MAIN DIA: 8" TYPE OF PIPE:PVC DISTANCE FROM CLOSEST M.H. TO { }WHY OR{ } SADDLE SIZE OF LATERAL: 4" TYPE OF PIPE:SDR 35 BACKFILL: DATE INSTALLED:1994 CONTRACTOR: WATER SERVICE // // MAIN SIZE:8'TYPE: 1. .TAP SIZE) SERVICE SIZE: 1 TYPE OF PIPE PAX DIST.MAIN TO CURBSTOP: (� DATE INSTALLEDh CONTRACTOR: f1 s5A to-6-/6 SKETCH: WATER SEWER-r, ---- +4"›* , ,, 3815 3817 ' t 551- 104'-j • • - _ _ Lek METER UP-GRADE FORM Date: // 7g- ?re-eF Address: 3 g L S i t?) / F e � b L D) Tech.: bOc Old Meter#: 6 j (o 6 If/ Old Meter Rdg. /g New Meter#: r7 a l 3 y c, -7 New Meter Rdg.: Transceiver ID#: /3 L/ .c10 7 D- Transceiver Location: L New Meter Size: — 3/`/S New Meter Styl IPE OMNI (See Below) ircle Style) Service Size: UV -e LL Backflow: (Yes) ((No) Check Valve: (Yes) (No) w J L - A S ti l t/ 5 y S-i-P., OMNI Turbo: OMNI COMPOUND: OMNI FIRE: s 1.5T2 1.5C2 4F2 1 2T2 2C2 6F2 3T2 3C2 4T2 4C2 6T2 6C2 Rev. 12/2010 Sensus ==de=: 106565 Line: 1 www.sensus.com :ate 8/10 I I I II II II IIII 1-800-METERIT =ar No: 12X2GBXX 1-800-638-3748 2esc. MTR 314S IPERL 1G 7.5"LL SAME AS 5390720600811 -NEEDED Customer HIM I III III I,III III III I Meter S/N: 72136467 Flow: 111111111111111111111111111 ,411 Lo: 099.5 Md: 099.4 =.099 9 Seneu9 111111 III III I IIIIII IIII Meter S/N: 72136467 NS f Certified to NSF/ANSI 61-G Order: 106565 Line: 1 Date: 8/10 1111111111111111111 SEn S V S Part No:I2X2GBXX WWW.SENSUS.COM• • Desc: 1-800-METERIT 1-800-6383748 MTR 3I4S IPERL 1G 7.5"LL SAME AS 5390720600811 •NEEDED 'Customer I IIIIIIIIIIIIIIIIIIIIII i Meter S/N: 72136467 Flow: IIIIIIIIIIIIIIIIIIU IIIII Lo:099.5 Md: 099.4 H.:099.9 7 Sensus IIIIIIIIIIIIIIIIIIIIIII Meter S/N: 72136467 For Factory Use Only IIIII 11111111111111111111 TOWN OF CORTLANDVILLE 3577 Terrace Road • Cortland, New York 13045 Phone: 607-756-9637 RESIDENTIALOR COMMERCIAL APPLICATION [ ] Water [ ] Sewer Account# do 7-,%. Application f : Bill to: . rip..../."9,' . V .,1.710/ 1ff idiet i _9• l_l _.5Y Phone: Phone: To the Town of Cortlandville,New York: The undersigned,being the GZ%f of the operty located at, ��75���� Owner,Owners Agent) � dos hereby request a permit to install a service to serve the �i (Water and/or Sewer) � at said location. esidence,Commercial) The name and telephone number of the person or firm who will perform the above work: For all new installations,plans and specifications for the proposed work are attached hereunto as EXHIBIT "A". In consideration of the granting of this permit, the undersigned agrees: (1) To accept and abide by all provisions of the Town of Cortlandville Water and Sewer ordinances and of all other ordinances or regulations that may be adopted in the future. (2) To maintain the sewer lateral from the building to the sewer main at no expense to the Town. (3) To maintain the water service from the curbbox to the building at no expense to the Town. (4) To notify this department when the water and/or sewer is ready for inspection,but before any portion of the work is covered. (5) Notify this department 24 hours in advance for inspections.All inspections will be done between the hours of 7:30 a.m. and 3:00 p.m., Monday through Friday.Anyone that requires an inspection other than these hours, will be charged for all overtime incurred by this department. Kind of meter: Meter fee: /, /,, 0 Meter size: .liDelue, 1i Water fee: �/`�'AG ___ G/ , y Meter No.: (o/v l Sewer fee: '� rd' � Register Head No.: Reinspection fee• Tax Map#: w`"20--D 1-if 1 O Total: Z'•a id- Signed: /2/ Date: /2Ll o (Applicant) / Inspected by: Date: Check if meter picked up: White-Office Copy Yellow-Field Copy Pink-Customer Copy TOWN OF CORTLANDVILLE 3577 Terrace Road • Cortland,New York 13045 Phone: 607-756-9637 RESIDENTIAL OR COMMERCIAL APPLICATION [ ] Water [ /1/] Sewer Account# Do z-- Application f : Bill to: 14,11/4:71 Ariv- • • A ,i14 /��,. / off Phone: Phone: To the Town of Cortlandville,New York: The undersigned,being the / of the operty located at, �1/,�X44je, Owner,Owners Agent) doges hereby request a permit to install a service to serve (Water an or Sewer) the *��� t�Il) at said location. esidence,Commercial) The name and telephone number of the person or firm who will perform the above work: FOr all new installations,plans and specifications for the proposed work are attached hereunto as EXHIBIT "A".In consideration of the granting of this permit,the undersigned agrees: (1) To accept and abide by all provisions of the Town of Cortlandville Water and Sewer ordinances and of all other ordinances or regulations that may be adopted in the future. (2) To maintain the sewer lateral from the building to the sewer main at,no expense to the Town. (3) To maintain the water service from the curbbox to the building at no expense to the Town. (4) To notify this department when the water and/or sewer is ready for inspection,but before any portion of the work is covered. (5) Notify this department 24 hours in advance for inspections.All inspections will be done between the hours of 7:30 a.m.and 3:00 p.m.,Monday through Friday.Anyone that requires an inspection other than these hours,will be charged for all overtime incurred by this department. Kind of meter: Meter fee: /0,V,D Meter size: Water fee: Meter No.: V6/64 9/ Sewer fee: Register Head No.: Reinspection fee: Tax Map#: LIO Total: •Z /, • Signed: Date: ?f 2L o ,� (Applicant) / / Inspected by: Date: Check if meter picked up: White-Office Copy Yellow-Field Copy Pink-Customer Copy