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HomeMy WebLinkAbout1625DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -17 BOX 15 k 116 1 T J or L I` , T I f . �. � mel 01625 W, PUT-NAM COUNTY -'DEPARTMENT. OF HEALTH � Division J0,CEnvironmebtal Y. 10512 CERTIFICATE.OF CONSTRUCTION COMPLIANCE FOR SEWAG E DISPOSAL. SYSTEM 97,72 :iPTO Town or Village,. Block Located t" Map."' Owner— AlwleT T ax.Hip.,Lot # Subd. # Separate Sewerage System built by Address. Consisting of * G© Gal. Septic Tank and xld?!� Other requirements Water Suppjy:. Public Supply From X Private Supply Drilled By Address Building Type No. of. Bedroo ms " Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed,serving the above premises were constructed e of which are attached), and in accordance with the' rdguliti6ns Putnam County Department Of.Health. Date certified by Address 6 ,tially as shown on the plans of the completed work ( copies accordance with the filed plan, and the permit issued by the R.A. License No.0 T Any person occupying prem.1ses served by the above system(s), shall Oromptly take such action, as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the seprate sewerage syste " M shall become null'ind void as soon as a public unitary sevior, " 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 10 modification or change, when, in the j4dgment of the Commissioner of Health, '$'uch'rPyocatI modification or change Is nee . as I sary. Tit la Date By C wne or Purc aasefo Building Municipality Building Constructed by Section Location St feet /• Building T e Block Lot GUARANTY OF SEPARATE SEWAGE 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 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 as 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, no.t. the ✓failizro of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated thi s elo day of 19_Z9 Signa Title 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 I VV"ikk li �'rai?t'� 9 R�'PQE�� P4TN *j COUMTY ®EP�►RVIE�l1�' T. T Division of Envirpnmontal Htalth Carviava COUNTY OFFICE 13UILDING • CARMEL•, NEW YQRIC . °ih(s rqpA>< ,1 @. � 4.9. lrampll�tecl by W411 driller and submitted. to. County. Health ;CepartnlDgt tot} eilae3c ..W7th>Ig4oF3storq�=1�F1AiB 04 ' -" sqr °s`,prnplq Indicating water Is o satisfactory bacterial quality before certificate of construction cornpliyncq ja yed REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF V+VELL COMPLETION ... _ .. MINIM ....... .M & H Custom Homes. ADDRESS '' Deacon Smith Hill Rd. �. _..__.--..---,-. � ,.....,.�..,,...�.4.,�•-- r.���� Hblmes. . E�Jr:!;FEAr4 of i:'[R !_.lair �P• Nadu _St;" / atYo 'Patterson (f 0I ompol nop s m jiss iE rVI DAkRE$Ti� t-� I §UPPLY {-� ESTAWSHMENq' � I �--1 FARW Alit ONDITIONINO t�-1 Q tE §T WEI.; OTHER l itTILIEMQ FOUIPMEE4$ (� L_J RQTAFtV ("''j COMPRESSED 'J AIR PERCUSSION CABLE PERCUS51ON "') CJ OTHER E5p?cifY1 .•.�•. a'�C6� ®rT+�I!•a iEh:C�TH (tppfJ DE6.t�EIER( Inches) WE ►GNT DER FOOI Q ''� TREADED Q WELDED S ., YES h'o us ONQ T01 L. J QA►I fJ HOURS jT J QUMPEO K1SI COMPRESSED AM 2 rr 0.1`44, 50 KIELP ((3.P,�Li 50 t� tiY[ M,iEAS.U3,R FROM$ 1,4449 �5UREACS- STgTIS(Speq!!y toot) DURING TftELD TEST ON) f total dra down Depth of Completed Well In foot (glow Land surfaces 2.75 GCREE M LENGTH OP&H TO Al?uifg? (14otd •'� VETAII,$ Sligl 410 plAljtETEtI (Mnghpel IF GRAVEI, PACKED$ Qlgmotor of well including gravel pack (Inchon): GgAl+f4 NZE l /n_chotl FRc7M ((FvM) 1P ((a4L1..• CFRT14 F "O. ".t LAND SMACE FQRMATIOtd DESCRIPTION Sketch exact (wo permengnt locetlon.ot landmarks, weft wltlt dtatancos, to at 19i ;1 FEET to fEET 0 42 overburden r 42 275 led g6 --if y1rfd was tooted at dif erani depths during drilling, list bolow f rECT GALLONS PER MINUTE . �„ �'lul.— CQMF1Gi PATE OF {3 PART V5)EL.4 PRILAXF% (51gnaturo' 1 / � , �� ar o SELL. ,O eL4IM is I I i f i APPROV old �Ilpfcxp- N d JAN nkAl[bt DIMION fJV; . GEORGE A r rHAUGHMEY, P rN a 47. 4 7 wI 1 5� I I i f i APPROV old �Ilpfcxp- N d JAN nkAl[bt DIMION fJV; . i iT Of NE �CONSULTING. ENGINEER SAP tHUR y4,p z rC,ti �F.Q Route 52 Qarme , Mew York 1Q512 *s, r * TITLEt Ze, 1 •n I fig. V� '��' �` .. , i "�� �ln NI ': /./r,+ + (I' .(gy. F 114.� ib.1>r. �,1 �' • 048g6� R�fFSSIONP� a, SC ALE ,� :DR. BY!►1 DRAWIfVG Nd, p CIS ATE fv <tis GK D: BY $T�NP^T o nn�.�.� .••.• 4 GEORGE A r rHAUGHMEY, P $T�NP^T o nn�.�.� .••.• 4 - - - -- - - !� — -� BJ TN Al 1 Division of sEnviroi►menta( Health Services, Carmel N." Y 10512 i z x `W CONSTRUCTiO1M P ­* tkMIT FOR SEWAGE-.DBSPOSAL SYSTEM ����J'OA✓ 4 , Town or Village "LOCateit et x. / /��"'�� Tax °IWlap=,�u_. r•, �* - Blocky :. Subdivision �/✓R!¢ C/�f. /La_ /Vi/9 �® Lot .. Job Y - 'Owner -" Address , /Jn/Gf� Building TYPe _ Lot Area Number of Bedrooms_ Design Flow, � ' Total Habitable Space Square Feet Seperate'Sewerage System to cohsist of ` ��� Gal Sapfic'Tank and c� To be constructed by �� / Address water Supply:. Public Supply, From Private Supply to' be drilled by Address.:. VA 7A. Other Requirements s - -1 represent- rthat l am wholly and compietelya•esponsible foY,the design and location of the proposed systems) ; -1 )that the separate sewage disposal ;system above described will be constructed as shown:on the approved amendment thereto and :in accordance with the sta Wps 1 ions o _ e u Hain County Department of Health, 'and that on completion theeof a Cert�fwate. of Construction Compliance i �� r °y`� t '` issionerlof�,Healthwill be submitted to'fhe Department,'_and a written guarantee will be.furnished the owner his:wccessors, heirs: i ns`dtill that said builder Will place, in good .operating: condition_ any part f said aewag`e d�sposel system, during the, period of two (2) years immediately- following the Gate- of -ttie issu- ance of the approval of ;tfie Certificate of.Constru_t,on Compliance of the: i Is'system'De any - repairs thereto 2).that ;the- :drilled well CesC�ibed above will be locatetl as shown on the approved plan and.that said well will be install i ccordance: wit the standards ruler and regulations of the utnam. . County Department ,of ,Health , ; Date Signed 5�9ned p.E `R e r Address !1"�%U%� COAL. �! Y ..• .���iY d License No. , APPROVED FOR CONSTRUCTION This approval expiies` one year from the date'-- issued unless construct_wn of the building has been undertaken and is reVOCable Or, use or may be amended or:mod�fi- when- considered nec ry by the`:Commir' or alteration of. construction Date rmit Approved for disposal-of-dome stic san s v suppl n1Y —.requires a new g a Title` PUTNAM COUNTY DEPARTMENT OF HEALTH V DIVISION OF ENVIRONMENTAL HEALTH SERVICES wt-:�tu...a•.�...:.; ��... .... .. w. nl.r.....�.. y. ' "COUNTY OFFICE— BUILDINGa, .: f A- RMEL, w ... v.v Y. .-:. 10512 :"'. wa . —•vas. � ... .. .a �ry ..+� .Kw .v.. tf.:Y'. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /1 f116j'T0N7 14 nwg ' 11(l Address .S% Located at (Street •des. Block Lot .¢ 6dicate neares cross s ree Municipality � Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole YX 4 as �6 /" Af Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 2 3,'10- 3.'30 ao 5 3 YX 4 as �6 /" Af Notes: 1) Tegts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 OF SOILS ENCOUNTERED IN TEST HOLES '-DRPTH' HOLE:-' NO. G.L. 6" 12" 18" 24" 30" 36" 42" 48" 5411 60" 66" 7211 4:00 _. _- HOhE:.N�.�.�.,,�_.�,. L �_ _ .�.__ - -� •- " 'HOhE NO .. �. -• _... _ .,-. ;I INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS— MADE -BY _ ;c: /� Date--- - DE IGN Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided wpo No. of Bedrooms Septic Tank Capacity vo Gals. Type ,4d'c�i�C2 _ Absorption Area Provided ByzC L. F. x2�+" ,e 6� + +e ° "° trench. " 'her ure S A S - Address ! o%E /��Z /% THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal'. Checked'by _ Date t`j f �V� i i 0C T Pu- 1,01i N I DEPT. OF HEALTH . . . . . . . . . . not 1"WA fV" I lw M swat 4 1 Z A o W AwW" I � - I - : i 1 ` , ;; 1W ps A �yy a Qe ry Lil a TS 4K I 1-04, JASA :AQ PQ n's rr .. ........... Oi Odra. F . . . . . . . . . . not 1"WA fV" I lw M swat 4 1 Z A o W AwW" I � - I - : i 1 ` , ;; 1W ps A �yy a Qe ry Lil a TS 4K I 1-04, JASA :AQ PQ n's rr .. ........... Oi