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HomeMy WebLinkAbout0863DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -47 BOX 10 lirs 'I Ti m i m6 �II:.0 Rev. 3/86 CER CA OF Located at- PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide" P.C.H.D. Permit N= 1 Owner /applicant Name VN 1 COQ ZL FXxISM&S LThForme rly Mailing Address 1oS46 Separate Sewerage System,ballt by UNICAP -1/ w 1�3 Consisting of / 7- ° Gallon Septic Tank Town or , Wage Tax Map / S-S -Z Block -Lot Subdivision Name QL*,L -R> -Sobel . Lot N 8 Date Permit Issued Address 2 STd�✓c �n ��Ct�- 5K/+ -�-I�y /0.5ZL Water Supply: Public Supply From (QzAa — iZlD6 - Address or: Private Supply Drilled by Address Bufldlng Type XA,4 o D Has Erosion Control Been Completed? V,S Number of Bedrooms Has Garbage Grinder Been Installed?o Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and re tions, n Accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date / /— ¢ —�� Certified by r P.E. �� R.A. Address L�f INS P`sr C'� A-T3 �y /d S%8 License No. Q�f3f Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub;': sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commisslonw -of Health, such revocation, modification or change Is necessary. Date 7 B ��— /� Tom✓ -s e -�. PUTNAM COUN`Y DEPARDIENr OF HEALTH DIVISIOLq OF ENVIRONMENTAL HEALTH SERVICES ()AIC©CN 2)\ a4(16 , • I 3 Owner or Purchaser of Building Section Block Lot Building Constructed by 'N'O 'A-\J) (,A.j4-'1 Location - Street ��A-AZO�j Municipality .e -S ; �► I� l Building Type OWL � e Subdivision Name Subdivision Lot # GUARAUrEE OF SUBSURFACE SESVAGE DISPOSAL 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 guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for period of two years immediately following the date of approval of the "Certificate of Construction- Compliance" for. 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 system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirental 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 the buildLng utilizing the system. Dated this day of F-e g 19 I Z Signature 6' �- Title �� c� General Contr cto (Own ) - Signature Corporation Name (if Corp.) a �k we Q Pry? ki V, Address rev. 9/85 mk J -,m Corporation Name (if Corp.) 2,0061-19 Kra {�peGrs(�I(� .i' Address ear m ®v �caaaxee I • PUINAM COUNTY DEPARIHENr OF HEALTH J a6V • 45> 77-44 DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA..SHEET- SUB.SUFACE SEWAGE- DISPOSAL - SYSTEK - - FILE NO. - Owner UA1 [C 0P2-,V 2W,09sTa s Address Located at (Street) ��✓�yJ( /j� G,q-�j Sec. Block 3 Lot (indicate nearest cross street) Municipality 47727 -X�4N Watershed - -7 • • • �I• •• •' / • Y• • D• • WON • Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME 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 2 3 4 5 Fj 5-'alZ s 3 _ 4 5 1 2 NOTES: 1. Tests to berepeated 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. rev. 9/85 70-4z TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. G. L. 2' 3' 4' 5' r 8' �l/ �V �� 1", l/ goy T/ 10' l/ - 11' 12' 13' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used JI O M.in /1" Drop: S.D. Usable Area Provided 57000,�6/�7— No. of Bedrooms Septic Tank Capacity )2J50 gals. Type COIVC- . Absorption Area Provided By 4 �—p_ L.F. x 24" width trend . . Other Address z6w S Op ltj y*-A0 /Ze Soil Rate Approved sq.ft /qal. .Checked by Date ptjrNAi COU IY DEPARaMU OF HEALTH DIVISION OF ENVIRCR4E9TAL HEALTH SEMCES �ET/�,c.HCp RE3IDS,NT�wI.. Csl uc.�c FAM1Ly � .. _ _ r r `DESIGN DATA SHEET- SMMACE S3,7AGE DISPOSAL SYSM4 FILE NJ. /r Owner %riE2MAQ 4- Ffor-- H Adress 9(- M ql ki STREET �r 1- 4AVILAWD D121VE A JD Located at (Street) f31z1 MSTotis49 ++%L1_ Ro.AA Sec. IS Block 3 ipt Z ! (indicate nearest cross street) Municipality ^'1' A T TE 2'� Watershed C,1Z o -ro N SOIL PERCDLATION TEST DAM 'REOC71RED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 1 r- s/ 8 (o Date of Percolation Test 1 f Z s / g b NU1BER CIIJCK TIPS PERCOLATION PERCOLATION . Run Elapse No. Time Start-Stop Min. Depth to Water Fraa Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min/In Drop 1 11;3o - 11:4: J Z4- Z7 2 1i -47 12:03 3 1 z,A4 - 1Z:Li 17 Zli- Z7 4 5 ' 2 R 1.o7 2 .. Z4- Z7 3 -7. o L3 1ZtoE3 ^ 12:30 ZZ Zg' Z7 �' V'3 6�1, 2 3 4 No=: I. Tests told repeated at same depth until apprc imately equal soil rates are • obtained at each. percolation test hole. All data to' be sub mittbd for review. - 2. Depth measurements to be made from top of hole. , f3 TEST PIT DATA RMULRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. _ _ _ HOLE . I30. .. _. ,G.L. ' 6t 21 • toAM wj �vvPFCS - 3' 4r S'. 6' 71 8' 9' 10' • �r 12' 13' 141 INDICATE LEVEL AT WfiICH GROUNDG m IS ENCOUNTERED N.)o Aj c INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING F.NOOUNTERkI) No N C DEEP: HOLE OBSERVATIONS MADE BY: M• svjtai P�)s1`i It, '���• CLARK ; DATE: DESIGN • Soil Rate Used 8 - ► o Min/1" Drop: S.D. Usable Area Provided 5 0 o o s . F No. of Bedrooms • 3 Septic Tank Capacity 1000 gals. Type Absorption Area Provided By 3 3.3 L.F. x.24" width trench Other Name RAWr ->0 t_R1 -4 W . LAWREN� - P. Signatur+ Address 2 3 . FA i .R Rt_n 7 Rive SEAL THIS SPACE FOR USE -BY HEALTH DEPARDENT ONLY: .I Soil Rate Approved scq.ft /gal. Checked by �+ t7 LJ z _ tv k4 mot sh T)A A C� C=:� C7 V— ���4(L1 i C.�:_�- "-,.=7Y a S7:= SE-Eft DL 1 -L �' ` Ac =L=S =;mac 10' i 20' f ?n0I 100' 13' t 351--• _ . L- , Dr_zre:,;E =T, L a _ - ! _ = m -_ C: :c Val l; 200' in D- r.•C•O, 150' Laall2z, _. 10' t-0 r:_t =r Li =- _mac r` ==: --�-"` r°�lM�.sn'au,= w.i�*d4- • =c.,:" %fig✓ �.�!:""" -i' °,, yJw„ � � y✓°'.,,,„ si cf C•h -_ =; C •._ ; (sue =- L _c) No Plans I� ! cam- �__= L-.c Z: srz Fez.. rec`z — c I __ _ Wall - -= i= C---- I ` - -- F_� r? & D Erg § I I ice_ Vic. c_ EC " =;mac 10' i 20' f ?n0I 100' 13' t 351--• _ . L- , Dr_zre:,;E =T, L a _ - ! _ = m -_ C: :c Val l; 200' in D- r.•C•O, 150' Laall2z, _. 10' t-0 r:_t =r Li =- _mac r` ==: t. ,fig m t. _4 4<