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HomeMy WebLinkAbout1185DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyoOrdocs.com 631- 589 -8100 25.62-1-38 BOX 12 1 rm I 1 0 1 1 V ILK! 1 J I � I Z 01185 PUTNAM COUNTY DEPARTMENT OF HEALTH 6 4 Division of Environmental Health Services, Cermel; N:Y 10512 fj Engineer Mast Provlde e o s • P.C.H.D..Permit N— — — _CERTIFICA ]F CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village . Z • . �/k1Z'F Ii:D lT V.G I jVjaP l4Q (o `.goo •Located st Block`...: - Lot Owner /appgc ant Name- W Nk' U LL I 'V.' " ""rmerly Subdivision Names " 5 bdv. Lot N f F Y��S Zlp Meiling Addres s Date Permit Isened ' Separate; Sewerage System built .by -� nI Aki - Addre6 Coneistln of L 0 00 Gallon Septic Tank and Elk) 8 WaterSgpplyd' Pa llc. Supply Fro Address or. 'Private SupplyD�llled by Address Btiilding.Type ,' _ L �� 1 1 �� Has Erosion Control Been Completed? limber of Bedrooms 3 ` Has Garbage Grinder Been Instilled? Other. Regalrementa .'I certify that the syst `(s) as;listedserving the above premises Kere constructed ess tially as shown pl s of the completed work, copies of which are-attaehed) and - accordance with the 'standards rules and re 1 actor ante wit f le lan and the permit issued by.the putnaai.County..Departm:� t' Of a It ' Oafs Certified Y ' i ' P.E. ZR . A. Po. `X z43 �nlo` t 46g ,Address License No. Any person cupyiny premises served by the above systems) shall.p ptly to a sue ct a ma4benecegury to secure the correction of any unsaMUry 'conditions r, ulti ` from such ;usage. Approval of the: separate age sy. em'fh \be o e nu10 as as a pub'_ senitaiy sewer becomes available ,ari she. pproval of the D►ivate water supply shall become 1 and W W n a Pu DIy; be mss ,wall.bli. Sueh app►ovaU sre subject. t if ehangei wnen, {n the 'Judgment of the ifsi er`- f eel suc n, m yeatlon or chanpeesa i CA- Li date BY Title C`9' l�l�l� Pd[S o OOf`�' 4WL�fr�G35P P�4nMG^Q(� ('�Mfr`�457 ©�Pl^Q�4�`1C;(�7' 4 �f�W' LQQ 1)1*160 .®Q 9"'Ar®tat 0 HC;JM ecrs..a COUPM OFFICE SUILDIP4 $ - CARMOL, RIM VC andvois3 of v�=r G'M' plo Ind1cming mvtoP Is of omld cYovV bodoPial gatelity Man mr0f1cm of canomwdon c omplia= la ifsszoeG . . NAMO Edward Sullivan ADnRQS4 18 Garfield Dr. Patterson, N.Y. a Ad o. root) am Uma0 18 Garfield Dr. Patterson, N.Y.. o 09) , UOU CP EI [n�Me ®O S4ADdIS 1�2F74 ®PAR�J ❑ QQ�ii CyQ� SUPKV ❑ INWSM94X ® COMO RIOaINO ®(S�pocrylt�y) QQ@ IIPP�IGWV ® QMAav a Al aPP acussla l ®P�RCUSSI ®a ® (� M Oq� PIRAM MGM (loot) 21. DIAM R(Inchco) 6 welow POR POO 19 ® TMAND ❑ MWO X VW m LJ ma U wo 4[I44 C7 ® ❑ GJ�JPI� f0 0URS m.v QA00W. ® toMPa2SS AIa 6 V OLD ( ®.6O LJOM UM& MRASURR PROSE LAND SSURPACO— SYAVIC(S pacify 10001 28 DURIN(b VIRLD MY (Poo) 305 D* 06 �w7 wd1 In oo0o blow Low cyo6s 3 0 5 MAU • LOMTO CWUM V6 Aeulpga (tor _UUjV1%xU__ pl=mu Om OP BaAM(2L PACff� ®ir�o4av of =11 IRAWIR7 pv ®opl �k ryaei�aJ: 00 (s DPq PC$ti"9 MPO BUM= P ®R{�A�� �SCa1GVI ®p 84010 ouact 1660flon at CM11 vith dlotosoq, b o? I= trio p0 monont Iandmofm PROY 1b POT 0 10 Clay overburden , Boyd Artesian Well Co. Inc. Rt, 2 Carmel 101 10 305. quartz 04 *M Woo PWWO ao dl knot dopoho dwMa delfta, not lolora V997 OALLONS PM M MLM MAIM YYRLL COMPLMD 12 -16 -85 D Y 1790 t8Y WELL O@116.LOR (SIono4uvo) 1 BREWSTER-- LABORATORIES- Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6091 SOURCE: Edward J. Sullivan Map 8th #149 -6 18 Garfield Drive Lot 6882 -6900 Patterson, NY r COLLECTED: March 7, 1986 BY: Edward Sullivan BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. March 14, 1986 Director i W t Owner or rurcnase,r'�of BuMLing Municipality Buis `+_,ng Constructed by Section ,1-b' ation Street 011 % ohm Building Tgne Bloc t1a ?00 Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drair_age 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 Piltnam +? County Department of Health, and hereby guaranty to the owner, his -succes- sors, 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 immediately following the date of initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to- accept•'tas conclusive the' de- termination of the Director of the Division of Environmental Health Ser- vices 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. _...........Dated this. _/7" .day of .�G�. u19....�1.._S�ignattire'?��lJti Title IXf orporatl , give name and address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE 'NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health R D&isidn, vv- Environmental 'CONSTRUCTION PERMIT FOR SEWAGE _DISPOSAL T .7 o� __ d' a t, Lot t S W7 �P I -A A 5t esign'F: ow - G Pr A D dmber:o s` Separbto,siweragd,Syiter".o f Pt PTO 'be,, constructed : �b y M t lic .,Water, supply u 0� Supply -ro P-r, -,"A d ress •,other Requirements represent that.1,arn wholly and completely ,,�responsible L J drj he' ­al 4ilfbe co'4ntte'ticted'gi'iho�4noh:ike,ip0r,ovbdian above - escribed Departnient-"of'� Heaitfi­ rldth t*--- J_ ipliit'i6m.ther'ec - I r - ! a�. _. - 8 , oq,-CPr! 6 d t6�, the Department, a-rid..-a Writtdn �j6iVihtee: wi e,-,suTotte ­i­, 11 '. I ace ,. in -',go rating c6r n. i lapy :Part of said -sewage ante "bi • ' ';ihe:appr6v4,:of 'the.Ceitificate. -of. �8irijirjAct�i &n'-'dori '6 ed a­i.s6oiwn ori'the approved _cl. will e'-Jocat i j Mat'd', - Address, APPROVED FOR CONSTRUCTION ':�,ThiS*ia' ro ell j pp revocabW ol r —or, If 'en onsi 1. f 'I _permit... APprbvi4�J,6r'. disposal .Z..-'req u res a. n(Lw. 0 e W Date 77 I. .. _. - . . - . ,, . of in'. ■ f T OF HEALTH Pe . =it. # p v lage 7or V4 I T-a)•'Ma Block` --Lot—, Renewal Revision. F!V,?1!S,.'Ap.pr0va1 Fill Section. P. H D y' Notification -R i", t4 S Y- sed system(s),, 1). that. the separate sewage .dkposal system - cordinee:w , Ith' - t.h b'stih6rdi;--rules and regulationsof -the, Putnam .jctio n ,Comp - liance"'satisfactory t6'the Commissioner of Hiiialthwill!, his successors, heirs or, A�ssignt, by, the builder; "that 'said'builder WIW lrnmi!idiital�, f6llow Ing thedate-0 ti ,per f wo,*�(2),years f h6 Aiu- t the,drilled well described, above indiz ace with `the si ards s' nd�rulatiqn! of the Putnam ense No., d unless e hs building has ee'' undertaken i,-'a'n'l s I 'r' of -construction" itia 6' o alt;i, 7 - Title I PttrNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES N TwnT[rTTr1TT r.TA R'T.IrI r+rmTry c+rTncrmZ,7� CLV.TAr- nTCY]lICTT CVC ICUfC i FIELD INSPECTION REPORT (Name ct.Owner ) (Street Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ............................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ..... ... ............ Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ......e ..................... D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft Soil Descr r- D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descr r- _ DATE: INSP. BY: - - - COMMENTS D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descr " DATE; FINAL SITE INSPECTION INSP.BYh YES NO COMMENTS House SSDS located per approved plan .......... Length of trench measured / Width of trench average Slope of tile line and trench acc le....a.... Roan allowed for expansion o1olo 0000 Over 100 ft. fran watercours ... .. . .. ... Natural soillnot stripped o SDS unnecessarly graded...... ..... ......... .... 10 ft. maintained fran prope y li e d 20 ft. fran house......... ... ..... . . Distance well to SSDS (ft.).... <. .... Number of bedroans checks.. ............. Stones, brush, stumps, rubble, etc., gr t r than 15 ft. fran nearest trench.. ....... 15 ft. of peripheral soil horizontally fran trench ............................. ...... Boxes properly set......... ................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. o, c PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH:SERVICES COUNTY.-OFFICE BUILDING," -CARMEL; -_V; Y: DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL 'SYSTEM FILE NO'. A-�t/ ._.Owner LL /�i Addres Located at ( Street) L ' Sec Block � - • Lot- ~ - ( lca e n9arest nearest cross;s ree Q Municipality, � Gl�� Watershed / /"001 SOIL PERCOLATION.TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS.. 'Hole . Number CLOCK TIME PERCOLATION PERCOLATION. Elapse Depth tolWater Water ve No. Time From Ground Surface in Inches Soil Rate - Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches C, ►4 7 Notes: 1) Tests to be repeated 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. 6 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.^ HOLE NO.n '? HOLE NO. G.L. 611 181, �! 3011 ` r .36 .4211 (. 4811. P r �II 6011 , r 6611 / 1 211 p 78„ 8+11 � INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE-LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN OUNTERED TESTS'MADE..BY -- .._._..._.... �_� .._ . 'Date-- Are- Soil Ra- -• •• S.D. Usable Area Provided y iI No. of Bedrooms Septic Tank Capacity Gals. ZOQ Absorption Area: �Provided By..�L. F W, -0 OM me Address _ SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date I 83.'79 1_171 ° 54-� ItJ ZCY7.ZZ` 1 (c8te3 (o ff 14.8ld I •I la8b ?I4SLo8I /,oP1o9I lu0-Lb l &,am 11o87Z 1¢873 I � S7`� I S ( a (-Z'? 4b -- oo '" / laPf3� 1�8Bb (,. 9IG89b X0891 l(°892 fo893 tii 1�1S�SS IC vi �.� Gass / / ��B9S \ �90b Im.Cfj 1 ` 6S9g a `��Ei L- LA NZAI&J �ZGPAe�E� Fd� 429° 210-oC�' E" ��' /vt.4i� or- PV7- 1„!,4/vi L.d.ICF. 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F'a Sox •2Q3 MAY 23'298b WC#j 14 oTr for .f"anoo with and Begaatlem of tbQ t