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HomeMy WebLinkAbout0859DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1-43 BOX 9 J' Li ;I Als I T� I f - �'� a ,61 11. '� PIMM .COUNTY DEPAFMMn OF HEALTH U1VJ.S 1.iJN Vr' . ELYVl.KUiV HALM sa(Vlc -* Owner or Purchaser of Building Building Constructed by Location - street MUnicipalit-Y Building Type Section Block -Lot Suhaivision Name ..... _ Ot1Lx1- 1Y1u1Lit LUL T v.n.nrnnr.wF 4-;,t +- T o+++ q.4 %^1 i[7 Dr%A- ^0%MV0p }plt7 +•he 1nr.e4. 4^vr i .1..4t- •i�- r14/iL W /L .. .Y. W.. V�r/ w.YrW V..r.. ►j rte... �/Y .Yry....a. ♦Vr yylti VbM ..+.W., wor)a=ship, material, construction and drainage of the sewage disposal system nnr,.; .... +4%% � Accnri }�i,. r ^pe�r't:1 .ter ri +-1H 4 ti, 0 }Jorge r,tructer as c&};r„srm .ern . the approved � ltm UL d}JFlLoVCL' _cWtCl11�Nf�C1t1L.. tilCrCL1 -V� ailu lit C�ccordance wi�i► 4i,G standards, rules and regulations of. the Putnam County Department of Health, and.. hereby guwcallL Lu t.Iie U1NS1Cl f' Al 3.� SUGcrSV%5, I1C:.rS or . Asw'�iy115,. LV '�I.LQtiC in good operating .condition. yWly PULL Ul. SUIU SybLein UUI15LLUULeu Uy MU WILLU11 Ldl.LS LU 0�eraL1r for a . pericd of two; years. -....� . a..e,.�Y lV1iLAM111y Lil= ua..a ­9 l• Qj. u i Va.6 G.L a.l /c "C:prt.i f cal:R of Construction Compliance ". for the sewage disposal. system, or any .....�J1 ....' ...7.. L.... ... i...' .....+L. ....wL�.r ►rtirNnJ.. �..'M�....+.. kZ....: ��:1........ 1... ...... e...�.L r. .w.�..... r.'1 .• i . .._._.. �.iJA- 'rs-rI�P1.e- UY -lt/ �.V -OLLWI O�- �1•. G/ 1,.._- �G1i v.��+t-- A�i..�4-"4Y�Or— .hN.L� iii G... to- A. V�G-i'K'LG tili.V�/C. ►.i:2•_. -i.0-: ...._....._.__...._. _. _ -. C�,�eeri i,e� 4�ha t.Ti•11 f�i] or nerT7 ie•ent arfi O1 the rg- M-vT�nt of i-ho j�n�ile�irrt titjllZ?neT . the system. The undersigned further agrees to accept as conclusive the determination of (.[[ -I U! IPIU1 JL U.L ,111= L/1V1S1Vil Vl iY /Vi4V1YlaP.111.G1" 11CG1611 -=I VILCS U.L LiIC rUL11G111 WU11L -Y Department of health as to whether or not the failure of the system to operate was �uµ:+awi i.i1 Li1:v '.'iir'..'�:.uw v� .1L•LJ,'r +'jr..... a:., ..� .1'L -" ......:1r ::1� L.1� r.l� r'ii.L :r'v:�il'j �w :..L.:. 1. i/wi�y . the system. Dated this Z 3 day of ��� l9� Signature �.•� /� / . *f_4 -fie ^. ^y•=rd Cogxrat:ion game (if Corp.) Ciirmra t i nn Names 0.f f Cori . ) Awrese rev. 9/85 mk .it . S ^r-�.. r, r dk :17s4''i•k .ix� ;H:nr`, i t.. s �: ki`:3c"kc%'g;}e Xi�]c y L.' 'T S', s YK�.._KET 1z 5h^ i 7- - `',a�-A a 4 ELD fTNSPECTI,0N I$TitftEIRAR�Y sri k 5� =�`�f: w�."4'•. v. '` y rh s Y.: ,�" ,41..':jT",k k•?:i4• J. a +nr?t.'� � L \�'',�'j.+4 �1k�u NV ,` e � ` � , 7�� , : s r-rj e � y 't �:,.•, -a � � y � j �� a, A s� �` +t �,�t��� e � �µ� ,'��� 5 � y 1 SJ`:1"Y r a ti,•, , :t�:+:c- ; w� •riF ZC.h ';«^"':Ji,14 ,:u�Si `aAa �' .- tt'.:pit 1., s�' ✓.:fkr't'.av,;yi �"" ?s a, ) I,A_e } , �y'•1 iiP 3' 2 •'���d 1 as K j ► RGET r 5t`� ^� ' $...� 4 y. ;p, `it. , tt a� ��• � Tfat �' `�'`r,,� . { S �•., 7. '�ck � y;, ,• a'� 4.0%�.� �� "'y�.•� ...-. "7.� -,�' ..r r.Vy�7�. .` �:�F..- \ .q'r C OWN;E1R i{ ; a a 1.., Fa e} '�•�.f h. y a rk' 'tttY a d i� t / k, \ is} f• '� pv }s ut}r y j„o j" r I L i , c ri klt, n �1 jGixNl'Aa wf1 fM `sti >, 11 . 1 TOWN T4 �✓ r �'�Y.� a � s � 4 'C l! � h1 ^ti 'n:,rt�. f r e p r it � e�7�,� Q ,% - C,a •'I s F+i i t 5 1 ti PERMYI�TTli`r�i d�Y``i w I q T *+ `' -, D�kTE `NOTIIFIE0 s' ,�Z�41 ,s _666 S. • ? rig ' �• 1 1 5, NOTI�F�IED� BY�� �1 '�- x• 7 } '?:'' a-y 9 Y � '` C^' kl�.e N [ sy s'. � � W.r. / t ` 1 ' , } +. � �u„v�' ` PREL'Ihl FINAL. TiPE 'INSPECTION FILL °SECT f4 k • . >i RAN Fr]Pr, cZ'T'F L�ISrFCI' -r Cates .. /O l0 8S. Ins _i v ;��. tGN CTNZ`a rrrA Su S1LG 'f C. vices f l »sue: wit-i inside of bcti d_ E =i1? n.at_ia1 ccn-t-2--ins stcnes < 4" iii di e_ Curtain =, n installer accordinc to plan I i czrtain C.r- ' n C•'L- i i or ect=,'� & dir. t0 G. ['--ct? n _r Q Ca_n= C L scharce aSvay t =CR1 S,5 area I h_ S -ac= •��t =� crct= =icn adc �,—=t I ' i _ CLC v icaa cII sl6ces C.Ce =t =r t = 12 45 . gim I YES No C M►��rS DISPOSrr, PQ.E3 a- SJS arm lc _ as r a -mrov ed p1a_�s I /� ✓ b. Data of Plac--I--rlt 2•1 barrier. LGZ'R W=.d AUG _DPTM c. rTat=,= scil nct stLicred I I Gt2) I I d_ S` -ne, br s et-c- ar ==t =r tin 15' f =CT[I S7S arm- I h�� I e. 100 ft- f_=. vater ccurse /w& i ands. S'EN1: DT rCES�-L STCT S a. 'C_nt;c t-it s_z_ - 1,000 K1,25] b. Eentic levee-1I I CrL a oo bcr+'_ °Q °.- �'lcut wit:r'_n 10 f= CE d�e. �110 i i scut _ -�a. emse e?- TTG�C.*1 - wa :ar t =s�� I I P cta� =-c:Y fres t I I hcx e^C i= `' -C'es M?n��LL -- CL1C?P�i Svl f . j-NL�_77TCV B cr=riv 'ce_ I I n� =- 11 �= QD • I I I 2 Dist ^_c = - wa __rc-_ _= r: =_^_ -,;rte -cc=rd . L*t c= a I i -- ,c to, L ian I Di ct nce C_ -t='' to c_- I I : �iCCe c= `__C:1 aC= =C� ^le 1�1� - 1 /32 GGt. I { E. 10 i—' - =uii CLCCe_' t7 l i re - 20 L— - i • De�t:� c= t== c� < 30 i_'iC: - f_ar� _:_r =_c= I i E Rcan �.i r'+ --CL ex-pim-^S Cn, 50% I 1 lo. rcCt1 C- =_ayell in t_=m al 12". jn?_n�i�Tril I I h_ F,_�sn CR DCc SYS= 1 SiZe of Gti c,; ta--. -k J . I I I c '.- cc 1 =_ n� n i ,mac • - P' c E__ _+ a. - _i�'J_ r',c._•ole �o CiG_. E. Crci w. - - -_- by Eeallth De=a2.r_.,Ent I I C_ _ 5 use 1CC=: _ C- Cc_ GC_i S I lG I I -wz 1r`Cr_ as per a7=_ c e.a plans I I I b. !,''_S tanC= f::=. EDS area f L _ I I C. C SinC 18" c: 7a CLade. I I arc: -C WZ! cCCG -r -_n i n_ C. vices f l »sue: wit-i inside of bcti d_ E =i1? n.at_ia1 ccn-t-2--ins stcnes < 4" iii di e_ Curtain =, n installer accordinc to plan I i czrtain C.r- ' n C•'L- i i or ect=,'� & dir. t0 G. ['--ct? n _r Q Ca_n= C L scharce aSvay t =CR1 S,5 area I h_ S -ac= •��t =� crct= =icn adc �,—=t I ' i _ CLC v icaa cII sl6ces C.Ce =t =r t = 12 45 . gim C.1`S YES I NO i I I _.I 1 I LF t=ench provides p0 r�uir � Op ft. max: ,e,�arzllel to contours 100% e,�p. X I-X f I tj". SLOPE SS P5 ` I X: FILL SYSTEMS cl avb crier I I 10 ft. X I fill notes new scec. = /1 RA1479 OF FIZZ depth gauges 100 ti-r. flood elev. I 200 ft. reservoir, etc. 150 ft. trigall /gall. X DOCMMM P7-_.rnit Application Corporate Resoluticn Plans -Three sets s/s Engineers Authorizaticn Design Data .Sheet Sheet ( DDS) SUEEDI<TISICN Deep Hole Log PCrc 6, Consistent Perc Results (3) r i _1 a //.f 70 C' Perc Hole Depth cd House Plans - Two set s Well pe_r;ai t; Fivj7S letter Vari ance Reosest Lecal Sudivision Subdivision P -cproval O ecked Mc-acoroval SEDS Adii. Lots Ciecked Wet'-and (Tcwn/DEC Per-nit R & D) Data On DDS Plans & Permit Sarre MQU RED DETAILSE CN PLANS Sewage System Plan - (nort'i arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volare' D or J Box;Trandz /G??lery; Pxzs details deils Septic Tank - `Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) - -- Design -Data:- perc -and 'deep- results.. -._ _ ..- . - - - - -- __ -_ -- Two- Foot,Contours Existing & Proposed Driveway.& Slopes Cat Footina/Gatte_r,Curtai.n Drains (discharge OK) Perc & Deep Holes Locates Representative of primazy and a := nsion Expansion P.rea;shcwn;gravity flcw,suff. size If Pmped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed.Systern-- Prcrty motes & Bounds House Setback Necessary (Tight lot) House Seder - 1 /4 "/ft. 4 "0; Type pipe No Be.-ids; Max. Bends 45 w /cleanout SEP.ARAIION DISTAKS SPECIFIED CN PT_AN Fields 10' to P.L., Driveway, large Trees,Top of fi? 201 to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Jake (inc. ear: 15' to Drains - Curtain, Leader, Footing 351to ©tch basin, stonrdrain,pi i Water OWE 10' to Water Line (pits -201) 50' intermittent drainage course Sectic Tanks 10' fran Foundation;, 50' to well 15' Well to PL 9 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health'Services AFFIDAVIT.- CORPORATE OWNER APPLICATION y FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: .Commissioner of Health In the matter ofy application for: represent that I/ am an offi1cer or employee of the corporation and am authorized to act for V,cJ1.e,oti�1 �-1�1�.�!'ralrrar', CIO. having offices at (Name of Cdrvoration) 7 Lil��oart -A� Whose officers are: y President: lAVcr \ -- (Name and Address) Vice - President: Name and Address Secretary: (Name and - `Address)._. Treasurer: (Name and Address) u,o ,J- y and that I am and will be individually responsible for any and all. acts of the corporation' with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this` day S Si ned: of ,G c, _ 19 Title: of y Public JOSEPH A.,GHIRARDI Notary Public, State of Now Qual 4755518 ified York No n Westchester: County Commission Expires September.3019_�� Corp'orat'e'S'gal 8/84 r "f IM PUITMM COUNTY DEPARZMFNT OF HEALTH DIVISION OF ENVIRONlENTAL HEALTH- SERVICES DESIGN DATA- SHEET- SUBSUFACE- SEWAGE DISPOSAL SYSTEM - - FILE NO. - - - - - - Owner %�.J �.�. -Zr'd� T,c_4' LTv. Address Co�Pa 2.. /'�a'�- �i,.rti, �''��o��G Located at (Street) ./.o,�A.�e ��•���A�v� Sec. /8 Block 3 Lot v (indicate nearest cross street) _ �Jad.L-�iJ Municipality / � � � .��- -�-ev� y� ,J ; ,� `� Watershed d, Fro r • a+ 2e r v Doom NOT IV UMNI e Date of Pre- Soaking Date of Percolation.Test HOLE NUK3ER C= TD'IE PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level- No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1,. 3 l- 5 1 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to'be.suimitted for review. . 2. Depth measurements to be' made fram top of hole.'Y` rev. 9/85 m i TEST PIT' DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. HOLE N0. - - -� - HOLE NO. G.L. 2' -� 3 T 51 6! .71 81 9' 10' 12' 13' INDICATE LEVEL AT WHICH GROUNI7D�iTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: - DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided .q No. of Bedrooms. ¢ Septic Tank Capacity /2�o gals. Type Goryc Absorption Area Provided By L.F. x 24" width trench Other.Z` . b • �. t iz. Name. .c,✓ Signat Address cr �*'Y, (,t�,� y SEAL ik ..�) Id -:M14 K W THIS SP TH DEPAR'IlMENr ONLY: �FQ �o. 0531b" pR�FESSION��' Soil Rate Approved sq.ft /gal. Checked by to i . • • . • , - . QO(JP7I'Y- D�AR'•Il'iFNP- OF: - i3FALTH: • • DIVISiC7N � _ r HEP►LTH $F�tVICES r .. DETAC- 4CQ Re3IDM i'i 1AL_C St ►.iCLC FAM���! DESIGN _ DATA ,.S==- SUBSMC.E SEWAGE DISPOSAL SYSTEM F1T�E N0. -- - y 9l0.. MAI" _STY.CET �sv ITC D� OWnef I-EnEtt MAQ 4- 40;' C H Address ar-itt06"-s `f A3 10-09702 • 1••IAYIf../yi.I'D DiZ)YC 4J.D - - •Located at (Street} F321 MSTo,�.C' "1=> %LL 'RoAV* Sec. • 18 Lot . (indicate neOrest cross street) Pi Municipality :TAT TE Watershed C R o 7'o1N SOIL =C N TEST DATA RMU= TO BE SM141 = WIT'S APPLICATIONS h Date of Pre- Soahinq 8 (o Date of Percolation Test I r Z s- % g b LOT ......, _... , PER(XILATIUN ` • _ ` _ PERC�T�ATION . wz Run Elapse Depth to Water Frcm Water Level No: .. ........ ; ..Grod Surface Rat" Inches Sow ed ' Start-Stop, Mina . Start Stop Drop In Min/Ln Drop _....... Inches 'IncYies Inches .. _.... r..•e...... 1 IotzS .,;Z. \ , 1 2 i ; 44 - 11 24...:,.,L.6 Z4.... Z 7 7 : , 5. 6 2 ,. 3 tr , r { NOTES I Tests to be repeated' at same ' depth u� approximately equal" soil rates colation test hole. 'All data `to° be : suk�nitt�d .are obtained.at each per for review. r. 2. Depth "measurements to be made fran, top of hole. rcpt Q /AS is TEST PIT MM PJEQUttEd:Td'-BE.;t --PLIMTION, '- DESC�ION 'ES 21- DEPTH HOLE NO. 1 HO M. J -7. =7777ne- r .21 31 .4 5 A tj p b-Z 71 caw Mu 81 L&JLAJ 91 10, 12! 13! 14' INDICATE, LEVEL AT WHICH- GROONDRATER IS -ENCOURIMD i 77 -7 INDICATE IMM To WHICH WtR IE\M,• RISES. A= BEING 'ENCOUNTERED DEEP HOLE OBSERVATIONS MADE, BY: M. uut,%i xa•,r-i CLAIM DESIGN F Soil -Rate -Used fa —7, All Drop: S. D., Usable. Area- .Provided. it No. of -Bedrocms Septic- 'T-ank Capacity. .. .1 nals -Absorption. -Area Provided .)3y,..-. x..24" width trench.......... . �PA m THIS SPACE' FOR USE BY HEALTH DEAARt,1ENr�" ONLY: " %10 ,Soil Rate Approved sq.'f 9,, Checked b� D'6� L- - 8e.' UA z 0 vnd/pl- _ - - - "This is to certify that I the sewage disposal system was constructed as indicated on this plan and that the system was inspected by m =- .before it was covered over. The j. i 58 9q' :.-A&m.uounty Lepartiment us neai" 4 1 6$ /or- S I 7, S ��- 6 z8 13 More -35 I 4t3 f1 ( 42- S.i ca 4S .5 fa * ID 1 (� ^ 2� 1� �•b ao 0 3 13 1 - /J 52 °00 -- N � � PuDUc Z� 0 � O r n co 7.4' 0 vnd/pl- _ - - - "This is to certify that I the sewage disposal system was constructed as indicated on this plan and that the system was inspected by m =- .before it was covered over. The i systea.was constructed in accordance with all standard rules and regulations of the Putnam County Department of- Health and the New York State Department of Health." :.-A&m.uounty Lepartiment us neai" •lvi@I of Ro onmental Health Service, ►pproved.ae.note Yor conformance tb ►pplioable'Hules and Regulations of tibe 4�utnnaamr4ounty Health epartment. q More Of NEW P. Cqe_ 00 * 4 3pCO y 08116 V' 0 3 - O I LT m�v PLAN X. o vrK• C. . 48� a sr W HOB 2- DD'V S5• 0 , CD LflT4 AREA = /.04 /A C. Z6�1 SP�liJy{ri.z5 %-ST yogmMI'l _ '7 n_Gn