Loading...
HomeMy WebLinkAbout0989DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 25.46 -1 -64 BOX 10 '�7 , f'• %JAC { -:� 'r 16 r r 11•:• PUTNAM COUNTY DEPARTMENT OF HEALTH Rev.. 3186 ��j Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide P.C.H.D.PermitN P 31 R ...CERTIFICATE.OF ONSTRUCnON CnMPI;iANCE FOR SEWAGE:DISPOSAL_SYSTEM _ _:PattersOIl Located at Manchester Quebec Roads Owner /applicant Name Anthon3.Jennette Formerly Mailing Address 17 [" c1 ztp 12.h (f 3 Town or V e Tax Map . 52_ Bloch Lot .5,,6 , 7 Subdivision NamZ i n m - T . keabdv. Lot q 46-5-1- 66S Date Permit Issued 9/5/86 Separate Sewerage System built by TQ h Q Berfrum Address i oo Fa i rf i e i d Q .i V t'- 13re 1� ? S�L' ir- Consisting of 1000 Gallon Septic Tank and 450 I.-E, X 21 Wide Trench Water Supply: Pablic Sapply From Address or: X Private Sapply Drilled by .Q E 13 t?Ci I rl SQO If Address R.Q. &-Ilk B a re o C fe Jr' 1 osoq Bnuding T,pe 1 fam. residence Has- Erosion Control Been Completed? Yes Number of Bedrooms 3 Has Garbage Grinder Been Installed? No 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 regulations, in accordance with the 'led plan, and the permit issued by the Putnam County D ztment Of Health. Date "Certified by P.E._ R.A. Address Cashin Associates P.C. Rt . 2 . Carmel -NY License NO. '26008 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, jinn the judgment of the Commissioner o& Health, such revocation, modification or change Is necessary. Date Title °� ;'t i t l �� _ ?(,q� . CM:': �Y`; s.�1,_ j !j: BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225-2072 — WATER ANALYSIS REPORT — SAMPLE No. 6444 SOURCE: Anthony Jennette Quebec Road Putnam Lake, NY COLLECTED: January 2, 1987 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method hose bibb — well 0 per 100 ml. --------- - ...... This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. RECEIVED FEB 111987 January 6, 1987 PUTNAM COUNTY" 1 DEPT. OF HEALTH Roy Bickwit P.E. I Director PUrNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENV.LR0ffV"IAAL HEALTH SERVICES Qri�h©r e�ffe SZ S 6.7 Owner or Purchaser of Building Section Block Lot Building Constructed by mcoldlester a Qua c -. Roe J S _ Location - Street {G�ers00 Municipality /1 1- CLert< <V KeSIde/ICe Building Type PI',f nM Lake. Subdivision Name 4653 Subdivision Lot # GUARAN= OF SUBSURFACE SE' kGE 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 a period of two years iunediately following the date of approval of the __-" Certiticate. _- of- .Construction._Complianre" for -the' sewage en,s.,Z steri 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 Environmental 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 building utilizing the system. 4 Dated this I o day of Fe b 19 ��7 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85. Mk Signature Title Corporation Name (if Corp.) IOU -F r e �c� i; `r i ✓e 3 �� �,)�, - . ess PV�N N�A�1E1 4 :s IV. V. VI. APPRMTX r FINAL SITE INSPECTION Date $ �� PION �fi��y, ..� „� z� �� ,.� �. U �•� +�� /� � OWNER _ Ins to b J P/! /� � b. Fill section - Date of placement 2:1 barrier_ LGTH WIDTH AVG.DPTH COMMENTS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier_ LGTH WIDTH AVG.DPTH c. Natural soil not stripped., d. Stone, brush, etc., greater than 15' fran SDS area. X C e. 100 ft. fran water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size 1,000 1,250 b. Septic tank install vel C. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set 9• TRENCHES 1. Length required - 3a Len installed 2. Distance to watercourse measured; ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 ” /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50$�,5 70 00 . 9. Size of gravel 3/4 - 11" diameter aW� .� 10. Depth of ravel in trench 12" minimum_ 11. Pipe ends capped' -- r - n: YUFiP'�lt IiOSE�SYSTEMS- ' - - 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Panp easily accessible manhole to grade ~j 5. First box baffled 6. Cycle witnessed by Health Department estimated flora per cycle HOUSE a. House located per approved plans. b. Number of bedrooms X, WELL a. Well located as per approved plans b. Distance fran SDS area measured C/ ft. C. Casin 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partiall backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours 9. Footing drains discharge away fran SDS area e h. Surface water protection adequate i. Errosion control rovideed'7 on slopes greater than 15 %. I!/JJ/ 4--- !i 1 A John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT'- Sheet 1 of ./ INSPECTION NAME ZTEXWE TM brig. Routine Orig. Complain ADDRESS (.�E$�G �, pRYt�RSbM Orig. Request 'No.. Street Municipality (T)(V)(C) Compliance Complaint Comp MAILING ADDRESS Final 'P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE Reinspection PERSON IN CHARGE Field, Sampling Only. OR INTERVIEWED _UgW Field Conference Name and Title Other DATE DATE OQ' /L�8'� TYPE FACILITY TIME ARRIVED � TIME LEFT iZ Explain 1 1020% Wro A7- .;" Z40'z°-1' 3" t4- 4 I.. 70 . ' .[ • .. s..• 1'. u INSPECTOR: 14"C D1 Ate TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: s-^•�-�m-,i. -"-.. ,z mss• - -; � ^f+^a".�,^,� ^-F. "�+'+x--°-"ri �,_,T�N-.+a"""��.."'"M j° .;'."�,r"t - ^� -,r r^-a -.'^-'.-'^� a PUTNAM COUNTY DEPARTMENT OF, HEALTH 2, Dlvlelodof Environmental Health Services Carmol N.Y. 10511 Engineer to Ptovlde Permit N on CERTD?iCATE OF COMPLIANCE i m .. r Permit #` 'I.ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �r - i, k A E a i ted at rV ,► -� ` Q V� �� �C a Town or Village 1' Subdivlsionl Niiimr rrt��%ivA ' L Renewal_ Revision Owner /Appllcan Name ct.('T+- lot�l4 wiS Date of Previous Approval '� S IS_ Maging Addeeee P it i. N +°�+ -� �� Torn IJ E i . �oC.�. EL L:E Z1e. ii Building 'T ype • 1 �A<i�� L�. 'Lot Are VT ection Only S a. l - Fill , De t6 Volume Nttmber. of Bedrooms Design "Flow G /P /D PCHD Notification is Required Who n Fill is completed Separate Sewerage System to consist of GeUon Septic Tank sad L t : %� ti 1prC 41 , To be constructed by nb— k ie•S Address Water: Suppl) : " Pdblic'Sapply From Address.i or:_ _Private Snpply Drilled by rY" Other Begairemeote 1 represent that) am. wholly and completely, responsible for,the design and location of the proposed system(s); �1) that the separate sewage disposal sy it m,: -- above described will be constructed as shown.on "the approved amendment thereto. and in accordance with the standards, rules an regu a ions`o e u nam County Department of :Health, and that on com'pleti`on thereof a °Certificate." of Construction Compliance" satisfactory,to the Commissioner of. Healthwill be - suDmittotl_ to -the. Oepartrhent, and. a written guarantee,wiil be furnished the owner. his successors; heirs or assigns by the builder,: that said,'bwlder ;will: place in,good operating ":condition any'.'part or "said sliwage- disposal system'tluring the period of two (2)'yearsimmediately foilowirig tMoate_of the issu ante of the approvaf.of the Certificate of Construction'Compifance of ihe•original system or any repairs thereto; ) that the drilled well described 6boJo i will.be located as shown on the approved plain and that sajd % eIILWIIl be installed in accordance with the standards, les and regu as iTfrons of the Putnam. - County Depar _ en of .Health. Date - , 'Signed . ��'"s \ P.E ss " l ti� �Cs . (*i. -A,� t i s L �� vice No Addis 2� APPROVED FOR CONSTRUCTION This approval expires one year from the Ldate issu nless construction of the building has been undertaken and is revocable for cause or may, be amended or motlified when considered necessary ''by the 'Commissioner of Health. Any change or alteration of construction - requires a new p rmit. . Approved for disposal of domestic :sanitary.selage, a or ivata water" sup only'. c Oats 9 — `.• _ Title ..... ,, proXa ° UAL 61 Subd Pre ious In zvA re ' Se an4_4 ula so s. am RE t s.,beqn undertaken-an is NI! OF TH PUTWM CO D UMY • EEIDOAJ21- • Al�- DIVISION • ENVIROMNM HEALTH SERVICES ---.DESIGN--DALTA.-SHIEET=SUBS.UFACE- SEWAGE..DI$PQSAT,-SY$TS(_.-------FILE--ND.. owner W-HOMY TENN-F-TIE- Address �Ln PFELHAM i�n, NI;__VV t;OCfk LLE NY Located at (Street).McA,.hester o( Qu4ec- Sec. 5Z Block riot L�_ (indicate nearest cross street) Municipality P A 11 E L Watershed Ct< U Date of Pre-Soaking -� 3 �96 . Date of Percolation Test 44 2 C 23 3 13 ROLE 2 10;03-0:51 45' o a3 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 9,05 .- �4a 43 19 z1 -3 14 2 �.,5v -I D3 3 43 9 zi 3 3 10,35 - i o 1 44 . 19 2-2- 3 16. - 4 11:2-o - il., 05 4 5 - H - 21 1 _� . - 15 5 3 -6-0 2-3 4 11:4 8-Q-'39 5I Z3 -3 5 1z: 40 j:31 51 :13 3 R E C: Qv am — z mi 3 y 4 WK. OF HEAL I-,I 5 NOTES: 1. Tests to be repeated. at same depth until apprminately equal soil rates are obtained at each percolation test hole. All data to*be submitted for review. 2. Depth measurements to be maae.fran top of hole. rev. 9/85 44 2 C 23 3 13 2 10;03-0:51 45' o a3 id 3 -6-0 2-3 4 11:4 8-Q-'39 5I Z3 -3 5 1z: 40 j:31 51 :13 3 R E C: Qv am — z mi 3 y 4 WK. OF HEAL I-,I 5 NOTES: 1. Tests to be repeated. at same depth until apprminately equal soil rates are obtained at each percolation test hole. All data to*be submitted for review. 2. Depth measurements to be maae.fran top of hole. rev. 9/85 f/ TEST.PIT DATA RDOUIRM .TO BE SUBMITTED WITH APPLICATION = DESCRMION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. ��e Are,l,ous Aroye►j 21 3' 4' . 5' 6' . 71 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: J FN c'e— DATE: el 4 05S DESIGN Soil Rate Used I -2-0 Min /1" Drop: S.D. Usable Area Provided 50oc No.. of Bedroarns 3 Septic Tank Capacity 1000 gals. Type (11C�r Absorption.Area Provided By �,3 O L.F. x 24" width trench \�S ` NAt Other CA fix•.-, , Name US H114 ASSOCIATES P.0 Signature .` '•' Address 3 7 FAt R ST SEAL .�` 260 O . A10; 2600 4 CARMEL (�.Y i05i2 FT��szA�ti� THIS SPACE FOR USE BY HEALTH DEPARDlETP ONLY: Soil Rate Approved sq.ft /gal. Checked by Date - uw`. -V -- c..,+.. �. �+ in�.w W,. i. �uwau... ww.+ C�i "..'�••- •S..rr.w+•+�rn.�M..•. /• �• . • •J1 m cy :lam• LTH - DIVISION • ' ENVIRONMERM :l9• Y: SEMCES INDIVBXM HATER SUPPLY & SUBSMU-ACE SEWAGE DISPOSAL SYSTEMS REVIEW S= - CONS'T'RUCTION PERMIT _ -__ • _ __ - _._._ 777--_ 7-e Y\ f\ . . � f� REVD: /a ou�le C I04d BY: Q, -- tion) DOCUKRM Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design.Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If Pir7S - Letter Variance Request RE QU= DETAILS ON PLANS •• 1� IBM • == mm Vall MEE MM M WAMM Sewage System Plan Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail. Well Detail, Service Line if over Construction Notes Design Data Tao --Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage,& Expansion Arm _nsio n flcwis'uff. Size" - If ' Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Lo,--ted Property Metes & Bounds House Setback Necessary (Tight lot) - House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. elan). 15' to Drains- O=tain,Storm,Leader, Footing 25' to Catch Basin 10' to Water Line (pits -20') Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked .Ex- approval SSDS Adj. Lots Checked h Wetland ('Town/DEC Permit R & D) Data On DDS Plans & Permit Same 2 a 9 1, o I I, Q Is si I 19 -- 60 1( Iff V s 9. 11.8;1 10' 2 a 9 1, o I I, Q Is si I 19 -- Iff 1.3 s 9. 11.8;1