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HomeMy WebLinkAbout1527DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -23 BOX 14 01527 y, 01527 PUTNAM COUNTY' DEPARTMENT OF HEALTH Rev. 3186 Dlvislon of Environmental Health Servied, a; Carmel, N.Y. 105-12 Engineer Must Provide C.H Permit N — "�.�.` D 7 :CERTIFICATE_OF.CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM -Town or it Located sit LJ C LET1' Tai Map _Block Lot Owner /applicant Name 'Mailing Address > o�7 Subdivision Noma Date Permit Issued tN Separate Sewerage System built by 6�' '' A'�' Address I:- Conslsdng of tip -Gallon Septic Tank and . 1 Water Supply: Public Supply From Address . orr Private Supply Drilled by L � ° Al Address /J"j7Vi41Y✓i /1 3 x&= c % ice.. Building /t'(��' %� [91y / iffy • Has Erosion Control Been Completed? Number of Bedrooms 3 Has Garbage Grinder, Been Installed? ;. Other Requirements !� R.d ) if 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 regula ons- in accordance' the fi ed plan, and the permit i d by the Putnam County Department Of Health. Oats � Z � Certified by P.E. R.A. Address..i I L sense No Any person occupying premises served by:the' above system(s) shall promptly take such action as may be nsCesOry 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 approvai,.of the private water.supply shall become null and• voitl when •a public water supply becomes available. Such approvals are sublect to* modification or change when, .:in, the' Judgment of the Commissioner. df Health, such revocation, modification or change is necessary, Date ' /�_� 8 � y%!�''L'���,�� Tit — Q PIJTNAM .COIINTYDEPA1C113EN�OFHEALTH 4� Rev: 3/86 X- Y Division of EnvlronmantahHeattL Sevlces Cermal. N.Y. 10511 REn� A r vlda Permit N ✓ 1IIUlII on to Pro CONSTRUCTION PERMIT FOR S WAGE DISPOSAL SYSTEM Penmit H . Located at uwn _.. f ar :village Sdbdivislon Name i�hs Sgbd. Lot N_ �� Tax M-0- ock Lot Renewal'_ 0 Revision O Owner/Applicant Name Date of Previoas`Approvai Moiling Address vi 0 Town ZIP ®. Ballding Type % /R� /4� �— „Lot Area A / Syc 4� FiB Sectlon Only . Depth Volume Nambee of Bedrooms Design Flow` G /P /D Q PCBD Notlficatlon is Regnlrod When' /Fill Is comPlotad rage �d � f I 01 Separate Sewe. G n To 6C­ � -� b s WatecSappl} Be $opp►y >!om Address or: Private Sapply willed by ' Other Requirements 11 , represent -t at I am who an'd completely: responsible forkthe design and locaton of the proposed system(i) 1). that the separate.sewage .disposal system above described ..will be constructed as shown on`ihe approved_amentlmeni the're'to aiid inaccordanca withfthe standards, rules an regu a ions o e ' u nam County Department of Health, antl that on completion thereof_a t6, ill.. Construction Compliance' satisfactory to the Commissioner of Health:' m be submitted to, the'Department,' and a`.wntten „guarantee:will be furnished tfie ownei,.hid wceessors, heirs or' ass igns by the builder, -that said builder will place: in good operating condition any part of saicl`i"age'disposal- system during the. period of two (2►,years immediately following thedaie of the issu- ance of : the' approval.` of.. the ,Certiflcate;of Cohstruction Compliance -bf the..o!Iginal system -'or,'any'repairithereto.2) that the,draled'well'descn99b��eC above will be'located as shown on the approved plan and that sa"d well will be ins ed__.i s o ante with t ds - rule g and regu a Mons . of ::th Putnam Couhty.Department ' of Health. P. E R.A. Date M vvr Address License No APPROVED FOR..CONSTRVCTION. This a rovat;ex _ _ pp pine on ear from.the d s ed unle ,con ct ion of the building has been undertaken and is revocable for cause or, may be amended or' modified.whencon d.nec sary. t 0 rn on�r "o _Health. Any change or. alteration of construction . requires a new �permit. Ap oved for disposal of Comesti Itary' s so d r p ivate' ater, pry only,' .� Date �!� rV By Title'_ { ,iw!s on of Environmental Health Services it provi�,,t as noted for conformance with ,(,pllca'lle Rules and Regulations of the PLAN Se,*.4,-: /'- S10' THIS IS TO CMTIry TT?!. -T THE SDWAGE DISPOSAL SYSTEM WAS '17.7) 01 T`! TS PLAN AND THAT THE SYS77' R: IT WAS COVER - ED OVET, IiJ ACCORDANCE * WITH ALL 43 OF THE PUMNA M MINTY U-211-IM-1V71T OF 3. F, C. 0. -0 3 .Scone AAK o 10 z 4-64,0S 7- 6. Saco Lar�Ei.✓ clor / /QvSuBVi�•csra.✓,F,vr�r[EO : SuBpivrsicw�l .�-DF�i�eoic.Y/YaaDS'fiLEo ,0EAe- 109r-e- 8 V MA1/,-Aje,,1 S1. 7, /9.7 IKY - - /2" SAnioY,loA/Yr -,P&rA1AV 4-0411V71 10eV Yd,6,C Z 70 y3• I' - 46' GeocE 'e".: Aeez' 3, /9B4 - I/ -/g. .1, — — 2<T ,&v: Ake IM " y of NEW 4- 7 33X— 0. 1'— :411, -76 014) a28 44 r: from the desk of — JOHN KARELL JR.. P.E. Director Of Environmental Health Services � Zl 7 �� .76 ENGINEER TO PROVIDE PERMIT # A��M4�e/ PUTNAM COUNTY DEPARTMENT OF HEALTH ON CERT FIC TE OF C PLIANCE. Division of Environmental Health Services, Carmel, A Y. 10512 PERMIT ZY I— CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM PATWKsou Town or Village t Located at (�/� t�i� w /-y / Tax Map....�y�,:_..` G..hea;v;tinn Mi% ®[J)N tJF eA 'f -,%a+a _ ,006c SWl. Lot H �� R_neval __[G Revision owner /Address ffj q.4 � Building Type Ajp_dl iGA)� Lot Area-- 2"'aw Number of Bedrooms 2— Design Plow G /P /D l0 (Q 0 Separate Sewerage System to consist of _ 0010 Gal. Septic Tank To be constructed by Water Supply: Other Requirements /public Supply From t_ Private Supply to be drilled by Address bate of Pe`revious Approval Pill Secti:om Only D.C. K. D.. aktification Required and -3a L� .�f ` �r�%�! /D`lJ.ifi/�PdN �CL Address I represent that I am wholly and completely responsible for the design and location of the proposedl tlystem(s); 1) that the separate sewage disposal System above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Connlpliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of iwo (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or anjy repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with tlhe sta rds, rt4jles and regulations of Putnam County Department of Health. Date �� Signed P.E. R.A. Address &®'L%11r_1® %_ ® °a APPROVED FOR CONSTRUCTION: This approval expires one yea/ncdslsa m th si revocable for c r maV' amended or podified when considered r by re quires a new mit, oved for dis oral of domestic sanitar e, anc Date .r 121 (i By Rev. 6/85 License No. unless construction of the building has been undertaken and is missMer, f ealth. Any change or alteration of construction ly only. Title ��� DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services March 23, 1986 William Zeiler, P.E. RFD #11 Box 242 Mahopac, New York 10541 Dear Mr. Zeiler: G� JOHN'SIMMONS, M.D. Deputy Commissioner Re; Proposed SSDS B a u I i e u Bullet Hole Road (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been comp/1. eted. Comments are offered as follows: Detail sheets are not signed and sealed. 12. The proposed well is not shown to scale 200 feet / - from the proposed sewage system. v 3. ' Standard notes 2 and 4 and fill- i l l notes_) ,' 2 and 3_are not provided on the plans. �j4. The design data, i.e., soil percolation rate and / deep hole soil information are not shown on the plans. 5. The expansion area is not shown on both the fill plan and the trench layout plan. �6.' Fill must be shown extending to full depth 10 feet beyond the edge of the trench and tapering 1:2 to grade at the toe of slope. / 7. The profile shows fill to the house. The plan drawing does not. Will the fill to the house also be R.O.B= TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 r - 2 - N. William Zeiler, P.E. March 23, 1986 Upon receipt of a submission, revised to reflect the above comments, this application will be cons'dered,further. Veer tru `yo jr I ohn Ka e 1, Jr., P.E. Director, JK:pt Environmental Health Services cc:JK File r• •• 1 �• • •�c I� • - ate• � r • � s r r I� v a�+• `1�i- •ice 111 i h 1• /• DI• :� I' M '1� /• h 1 • •� Y� REVIEW SHEET - CONSTRUCTION PERMIT j MTE 312 4 BY: (Street Location) DOCUMENTS -; Permit Application , Corporate Resolution Plans - Three sets 3`f Engineers Authorization" Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow, Fill Profile & Dimensions - Volume D or J Box; Trench /G, 11 T- � s Septic Tank - Size, Detail - Well Detail, Service Line if over nstructon Notes; Design Data Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area F arision Area, *hon gravity flow, Buff . size If Punped Pit & -D�Box Shown & Detailed House - No. of _Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, large Trees 20' to Foundation Walls 100' to Well; 42Q n-7D-.FQ-.'�EP,, 150' pits 100' to Stream, Watercourse; Lake (inc. expan) 15' to Drains- Curtain,Stonn,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (TmM/DEC Permit R & D) Data On DDS Plans & Permit Same MMI• ee I34 ��* DESIGN -DATA= SHE Er- SUBSUFACE..S&QAGE- DISPOSAL- SYSTEM DE _IU,:.:�.:.:__ Owner bf VIt') ULl Address (_y, Located at. (Street) C '7 , LCs Sec 773 _ Block Lot /=l (indicate nearest cross street) Municipality /��t rG� d=�� Watershed SOIL PERCOLATION TEST DATA RDQUIRED TO BE SUBMITIHD WITH APPLICATIONS Date of Pre- Soaking Date of Percolation 'Test 'Z- P(o SOLE NUMBER C= TiME PERCOLATION PERODI ATION �\ Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop -� Inches Inches Inches 1 x:05 &: /o `' 3 47 4 5 1 I: /sue 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until.approxi.mately 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 TEST PIT DATA REQUIRED:TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO MHO r - ED G.L. 1' 2' 3' 4' 5' 6° 7' 8' 9' 10° 11° 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: DATE; DESIGN Soil Rate Uses f'–/0i Mi /1" Drop: S.D. Usable Area Provided .S°"9 ¢St ® L No. of Bedrooms Septic Tank Capacity ./A" gals. Type Cz -A10. Absorption Area Provided By 3:3 L.F. x 24" width trench Other I. -I- A,- A 6, C.G. ;5-0 U (!Y, 1,A 7 C, &—i_.- _ _._ Name Address it ,Ai''( Soil Rate Approved .sq.ft /gal. Checked by Date f _ I ,- r PUTNAWCOUNTY D PARTMENT,..OF HEALTH ENGINEER TO PROVIDE'•PERMIT # ON CERTiFICATE OF COMP IANCE ' Division ,dV-- ,Environmental Health Services Carmel N :,Y 10512 PERMIT # IT FOR SEWAGE DISPQSAL SYSTEM Located at iA Z/ Lf Lj� /C� Tax IVISP 7 Block Subdivision —VV i '% � �fi% %ii�IG' &Y.Psulxl. Lot N ,� ``Ren�ewal7 Revision owner /Address . � ..V f_.3 Ol.L �1%/Q''eAI``��L Ir �(p�'�A/t{fte`6f Previous Approval AMA Building Type ' �- Lot Area A Fill Section only 1 ' Number of Bedrooms 3 Design Flow G /P /D 90 P.C. H. D. Notification Required A 00� " s Separate Sewerage System to .consist of .,] Gal. Septic Tank and 'To be constructed by. —„ -rA !�L� /� :M Address ,W ?mss ✓L�3lJ�j�A/ ' �(�� ater Supply: Public Supply From L� is ,�r1 "I`� 9 �ic0 "' 0K Private Supply to be drilled by �fZ ..11 t3 /t✓� i/h+ Address' A Other 'Requirements �• ' 'Ka V, A -X/5i 1, (represent that i am wholly. and completely responsible for:the design and location of the proposed system(s): 1) that the .separate sewage disposal' system above described_wi11 be constructed as shown on the approved amendment there to and in accordance with the standards. rules and regu a �ons,o e_ u nam County Department of Health, . and that.on complefion thereof a "Certificate' of Construction Compliance" satisfactory to the Co`mmissionerof Healthwill De submitted to'the Department, and a ;written ;guarantee will be furnished the 6wner, his- iuceessors, heirs or assigns by the builder, that said builder will place in ;goon d operating, condition, -any ,part of sa,tl; sewage •d�aposa system; during; ;the period of;two (2) years immediately, following thgdate,o the issu- ance. of the approval of :the Certificate of,: Consfruct�on Compliance, of. the'onglnal system'ok any. repairs thereto; 2)-that :tho dulled :w,oll `described; above 'will be located as'shown on,the approved plan and that said well "will be installed' in �cc" Banco with the dard3; rules and regu a�'ons ° :of the utnam County Department offHealth. �- Date. �� V Signetl P.E: R.A. Address� License No. APPROVED FOR ON TRUCTION: This approval expues.o.ne .y i fro' the date issued unless c nstruction of the building has . been undertaken and is revocable. for ,ca or.: ay be' a mended or modified'when. consider d n scary by he Comini o r. of Health. Any change o► alteration of construction irequues.a. new ermit proved for disposal of;domestic'sa y ewage,'-a /o i t r supply only. pOete By Title - ,:Rev. 6/85 �- PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SE9MGE DISPOSAL SYSTEMS _ _ ii DATE^ Z -' Z-�S INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CCMNTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will.driveway 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 .. ........................... D.H. 1 Lot Depth to G.W. Depth to rock Soil Descri tic 0 ft. r v 3 ft. 6 ft. �v 9 ft. �l 12 ft.- 'V.. 1 D.H. 2 Lot Depth to G. W. Depth to rock 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.- 5oi.i uescrri t DATE: FINAL SITE INSPECTION INSP..BY: YES Soil Descripti, 0 ft. , 3 ft.'" .3 -n ;� 112c) y j 6 ft. ` 9 ft. J II b u es 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.- 5oi.i uescrri t DATE: FINAL SITE INSPECTION INSP..BY: YES NO CCMM'>ENTS House SSDS located per approved plan .............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allaaed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ........ 10 ft. maintained from property line and 20 ft. from house... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones; brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally froan 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 .................. A .3 -n ;� 112c) y k ` c.. C.'�r i eC' J II b u es - i in t v`S e c ti I Q w� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner gQ ,�f� /� g4JI4L Address ! Caq Aa z ey 13AI.60� eMZ /� /• Located at ( Street V4 L,� - -Sec. %S Block � Lot l / Ydicate nearest cross ss reet) Municipality �,f7r,����V Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS. Hole Number CLOCK TIME PERCOLATION , PERCOLATION RIM No. Elapse Time Start -Stop. Min. D-epth to a er From Ground Surface Start Stop Inches Inches Water ve in.Inches Drop in Inches Soil Rate Min. /in drop 3, 3 .2. 2,.2-1 LIE 1Z a? 3 2:3g 2: �o z Z7 4 2 : Sg . 3 : 20 Z -2, 2_ 21 3 7--3 5 .z)� 27 :Sly 3 3 '0500, f 2.6 2 / 2-7 4 3:31 3 ^ r 5 1 2 4 5 HE ETN A R• r.-.Q aNT-Y �'ii�FiT�� � ®S�'►T -- DEPT. OF HEALTH Notes: 1) Tests to be repeated at same depth until approximatelyy 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION _DESCRIPTION . CAF: S.OTL�o :t NCOUNEtERED :_IN. TEST..:liOLFS- DEPTH HOLE NO. NO. 2- HOLE NO. G.L. - /off ,�b /I- 6" 12" 18" 24" 30" 36" 42" 4811 54" M .. 7211 781 8411 —7,—' INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ��N� " INDICATE.`LEVEI; "TO !ITCH WATEJ3,LEVEL RISESAFTER-BEING ENCOUNTERED TESTS MADE BY 161-1 R�oZffl-2— Date DESIGN Soil Rate Used Min/l "Drop: S. D. Usable Area Provided _VX _&X1o,1'' No. of Bedrooms a Septic Tank Capacity /600 Gals. �©,rdG? e Absorption Area Pry d By 13 3 L.F. x24" jb tRE"' '' c gyp, TA mP 141,j, , ".A.44 Si ana ure Address XPM011 AA-,;�' 2, SEAL THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: �� pROFE'�� -z Soil Rate Approved Sq. Ft /Gal. Checked by Date