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HomeMy WebLinkAbout1663DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.17 -1 -9 BOX 15 Is m I I I i.y% i , . - :� T ,. ii. III I , 4i�; i i ;� i ly Ir A � , _ �. ir 6 ��� �' � r - ' t� �r ol 01663 .x -�,._ . _..m.. �•-n?�:,."' "'a...,sM.,� r��z -. - .m- -•:^yr+r� ,aS '+'TM7G•.,'+.';�^roStq- � T � ( � Rev. 3186 PUTNAM COUNTY.4DEPARTMENT.OF. HEALTit /wq Divlsioaof Environmental Health Se vicex,�Cermel, -N.Y 10 \ gyp; • J � - rr CERTMCATE -OF CON - UCTION COMPLIANCE .FOR SEWAGE DISPOSAL SYST Located at Owner /appllcanf Name . ,• - Formerly - Subdlvteion Name •Spbdv.•Lot' N ' Melling Address :LION& Vie 90_A t1," 6/ t N Zip 105 L s­ Date•Permit Issued Separate Sewerage System bull! by •46VI k.&1411 Address 1 Consisting of , IOC Gallon Septic Tank and —_e2 LF d F 4 %_!- Water Supply: or / Pnbll Supply From Address V Supply Drilled by t &- Address(zF�nIr7'- llulldlug Type Has:Eroslon Control'Beeu,Completed? Number of Bed ooms Has Garbage Grinder Been Installed? . Other Requirements I certify,that the system(s).as, listed 'serv,ing the above premises war a.conatructed esaentially,as ah the pl s of e d work (copies of which are.,;atteched),_and in,accordance.witti ahe standards; rules and regulations; in 'accordance ' he fil -plan, it issued by the Putnam County Department Of Health Date + 8x Certified by R.A. Address _ oX . %/ 3 . �t"ta tVtl�- Y,�l� --i0. iYt License No 44.,6 Any person occupying premises served by, ,the above. systems) 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'antl vold.as soon as a. pub:!: sanitary sower becomes avallable and 'the approval of the `privateiwate► supply shall become null and vokl when a public "ter"-supply becomes avallable. Such approvals are subject to• modification or change when, tiin the tJudgmsnY`of the :Commlisloner of:�ealth, aueh re n, ;rrioalifieatlon of ehange Is necessary. Date By ' T 0 b/It1111N11 fdl 110111111111611101 Ilvellll yplv1100 a ®' CODUTY orFICC DuiLDIUC • CAnmCL. NEW vi 'Shia report is to be•completed by well driller and submitted to County+icalth Department together with laboratory report of arWy;i; of water ;ample Indicating water n of satisfactory bacterial cluility before eertlfiriote of construction compliance is iitucd. REPORT tpUST HE SUBMITTED WITHIN 30 DAYS OF WUL CO.-APLETION crWRIZ KEVIN & EILEEN KELLY Longview Road, Carmel, NY ®CATIOk 65. the. 6 sl,oey, oar (T of µo1 irlrinoor/ OF trrEu Fair Street' Patterson, * NY 35 . 0 ® ® tDPOSt® ® DOA4E37IC $SIAZLISHMENI FA8A4 TEST %VM tlSt OP ' WIll j INDUSTRAE j� CONDITIONING—' CO ND RIONING • OTHER tipo�idrl aI UING i 1 jj COMPRESSED PIRCUSSION ® CABLE PERCUSSION ® OTHER ]LIiPF/[IdT' L�J ROTARY AIR Isoc.:(r1• CRSIHG tlleGla (IO01j ( taAaALILSI /nCA081 wcnorsl Pla 0001 ( tr, �� jjUla��d[ SMOTj''� I ^AS LA G C��v�iJl - " a I DETAILS 7 5 6 ]� 9 THREADED WELDED I.XYES L H U TES WO Al VIEW nn HOUeS D 6 G.Pan. 7 TILtD (G.P.0 j . 7� • TEST &AILED PUMPED lX_: COMPRESSED AIR WATER A%LASUiE PLOln LAND SUaFACi— S1A1JC(.pe9*/rl96 t/ DUSIf:G ifLLD TtSI Pecs) Depth of Cornpleled Well tiltiL 61 300 o In f¢ot below Lond svrtoce: 360 Jtti.ieF lNG1M O►L:1 TC+ AGL;1FLi S'CRFfK DLTAl:b UG1 1:i 0IA4AL1LS pncnoa/ IF GRAVEL I Woreeter of wall inclvding GQAvLL S;U (/ncnes) 120AA heal/ poop RACKED: prowl pock (1n.A1 I10 1 a ►i ✓m t411*'171lA:!1 PER to P[El ; POR"TION D.S007TION 0 60 1 Hardpan 60* 65 Medium to. hard 'fractured bedrock 65. 360 Medium to hard grey granite . o If'Nlet was ivolool 01 oiRarom t3sptAo alrrints 4411 :n0• Lot boiew PEft cAUO►+S r(R )AINUIE SMOICh orJ3C1 I000110n CI -Of .1111 O /ilaACei. 10 Of I®aaf two porenononr lonomarns. /,00 pro, . 1 I- - I , . . I . 01,&; A S ;ttt a.c1.�.lttlo a I- - I , . . I . 01,&; A S ;ttt a.c1.�.lttlo @RlNTER L4�OR4TORIES ..... . _ - �- .- Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6117 SOURCE: Kevin Rielly :Jell Fair St. Patterson, NY COLLECTED: April 4, 1986 BY: Nall Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This indicates res It o r he u the source ce oft sample le w as of satisfactory sanitary quality when the sample was collected. April 12, 1986 f PUTNAM COU91Y DEPARTMENT OF HEALTH DIVISION OF ENVIRON[ WAL HEALTH SERVICES Owner or Purchaser of Building C� I j :- Building Constructed by Location - Street Municipality Building Type °1 ` IF Se � Block Lot Subdivision game Subdivision Lot # GUARAIq= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that .I am wholly and completely responsible for the location, workananship, 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 immediately following the date of approval . of the "Certificate of. Construction Compliance" for the sewage..disposal system, or any repairs iaade' oy' nie- to -such system,- except where the failure" to lope 'ai.e -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. Dated this day of 19i Signatur General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Title ww 2-- Corporation Name (if Corp.) Address V. ENGINEER TO PROVIDE ,PERMIT. # j PUTNAM COUNTY: DEPARTMENT OF HEALTH ON.CERT IC ATE 0 - COME L,IANGE -r! e Divisionrof Environmental Health Services, I,arme! N ,Y 10512 PERMIT .CONSTRUCTION PEfiM1T FOR SWAGE _DISPOSAL SYSTEM 477`'' *),� Town or illage , 4 C atodd, _ r _� Yax N!ap� Block-I- Subdlvis�on iJVU r r' S "SUbd Lot A� Renewal Revision _ ! a Owner /Address Date Of Previous Appioyal ' F Building Type Pill Section only (] �!z / ^� tl/D •.. P.C. -H. D Notification Required . ;Number :of Bedrooms Oesign,Flow G P p'' d Separate Seweiage System to confist of f %L3L "' Gal Septic Tank and To be' constructed by Address y Water Supply Public. Supply •From. P ivate Supply to be drilled by aiddreis Other 'Requirements i represent thattl.am wholly and completely!,respons ble for the desii ' —d location of the proposed system(s); 1) that the separate' sewage - tliSposat:Syftem above descrvbed, will be constructed as shown`'on the approvetlbmendment there to antl in accordance withlhe'itandards rules an - regu a ions o >. • e Putnam County ^:Department of Health, and that on completion thereof a Gertificate? of Constructiori,'COmDliance satisfactory: to the,Gommisiloner ' of liealthwill be sub_ mRted to'••the Department 'and a'.w"itten guaranteedwill be tfurmshed "ahe owner, his successors,. heirs.oc assigns by the.bullder,;that said builder .will place in good 'operating _condition.` any part of said sewage. disposal system zduring ;the period of, fwo (2) years immediately fo owing thedate of the issu- ance•of,'.the approval of:ahe.Ceititicate of�: Coristruct�on'Co'mpliance of the original system or any .repairs {hereto 2p;that't filled "well describeG'above . will be located as shown ori'.the appYoved plan antl that said wall will be installed m accordance 'r he ,hand ds, rules n r a ns, of the' Pu4nam County Departure of Health° I F �'` � ` - •. • bate.: Signed, !It'' P.E. R.A. Address z. Z r Lice fie No ' APPROVED FOR,;CONSTRUCTl(jN Thzi approval -exp res one y"a... rom the date issued ur!less construction of a building'has� een undertaken and is revocable' for cause or maybe amended ormod�Letl when cons�deretl necessary :by the,;:Co issi6ner 'of. Health., ny change- or alteration of construction regwres' a new I permFt liDProved for disposal of tlomestic sa tart'' wag ,'and /or 'pr wl,,y Y. �y Oate_. Bev. .!5Z85, . • e 9 LL / -Ar -7 �-1 r 4 'f -- - -- %Z 7-4 V �•i - ` t i C,-i -7K PUTNP,M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONmEalAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS _ , ... FIELD INSPECTION.. ZZI r y %alt. FrCc.C�^ IN P. BY: ( Name of Owner) ( Street Location) INITIAL SITE INSPECTION YES NO CONII�ITS . 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 ............................ Access to r)ronosed well location for drillincr..... D.H. 1 Lot Depth to G. W. Depth to rock 0f 3f 6f 9f r 12 ". - j. D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. :.... _L �"-2 ..f�. Soil Description D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock DATE: FINAL SITE INSPECTION INSP.BY: YES NO COTS House SSDS located per approved plan.............. Length_of trench measured ej Width of trench average Slope of -tile line and trench acceptable......... Roan allowed for expansion trenches...... ......... Over100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded...... ..... ! ........ 10 ft. maintained fran 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 fromtrench....... ........................... Boxesproperly set......... .................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage.appear OK in area of SDS....... ,FINAL GRADNG OF SITE ACCEPTABLE.. . ................ r -' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES M' COUNTY OFFICE BUILDING, CARMEL, N.�02 .� ., .._. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner AddressirLr5y2/ Located at ( Street) Block Lot s n lca e� neares cross s re Municipality, jUti Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 3 0 C S7':,3 Number CLOCK TI4 l� PERCOLATION L� i PERCOLA_TI_ON Run Elapse Depth to Water Water Level No. Time From. Ground Surface in Inches Soil Rate Start -Stop Min. Start. Stop Drop in Min. /in drop Inches Inches Inches /E /7 U -3 . 5 3 0 C S7':,3 4,6 4 -/� l� �� Z 3 0 C /6 2. 4 -/� l� �� L� i 6 5 Notes: 1) Tuts 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 DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. atjyf�ta/ 6„ 12" - r 18" 24" 301 r� 3611 42" 48" i 54" t 60" , 781 , f 84" :_IlVIJCATE:TE�IEL AT WHICH ,GROUND WATER IS „ENCOUNTERED,,..,_..__.:�i INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY i7 Date i� DESIGN Soil Rate.Used ,�--7 Min/1 "Drop:. S.D. Usable Area Provided No.. of Bedrooms Ji Septic Tank Capacity/0-0 Gals. i Absorption Area Provided �y ,Gifu -_ v I `x4 ` Name . �'>lcc.4 u� signature Address sf Z-` SEAL �. THIS SPACE FOR USE BY HEALTH.DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by, Date _o WELL PKi,qr-, TO t-07 W '05 5cz FT A -Ox 'e-r L., 0 t'l GOW- Ff)O-TIKICa Sovj F;rO,5,:T rL,Al, � :5CAL,�, 42 O'p IOX e4l- MA:50�1i?-Y etc -iAt4- (aO L.F. OF -1 -4 L-ALL-r--Y-, Hou,:;a v\i emu. GKi \1 a;WAY L,OCAT!Ot,6 AS eye- SUV-,Ieiy 2)y -10 Hw50,,-1 l000 �-.AL, -'-At. ti &b L.F. OF TANK LAgr 9--1X Z'- to" 29.0. C.O. f 32 ry8 O'j 49 u b11— CouritY JJePa-rTm8n1, ui nua.LLL :vision of Environmental Health Servica� ' ?roved as noted for conformance with ,E,licable Rules and Regulations of the LLtnam-County Health Department. ,ienqturp A .1. nnto T/Aq' FAA' PAIZ ST.Q 1FU7 tJAM CO. T- .'AA i ALY P. e-- ICH4C, 0