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HomeMy WebLinkAbout1822DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -46.2 BOX 16 17-2.mi 543 1T, .� 7 01822 PUTNAM COUNTY DEPARTMENT OF HEALTH r Q' e ij. 318 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer 1Vlast Provide" P. H.D. Permit N — =— — CER . C OF CONSTRUCTION COMPLIANCE „FOR SEWAGE DISPOSAL SYSTEM GATT 6F—,Go . .�_• ..:.� _Y•.... ,..,: t <. = town o ,. rV.illage Located at `�l, �j��� �� 'pa�,.�A � D Tax MAP Block _Lot �- Owner /applicant Name -Wl WAAAta- 9VTO& Formerly Subdivision Name w Mlgb, Snbdv. Lot N Mailing Addreae FA zip i%6 6 2� Date Perni t lasaed "�� �. Alas Separate Sewerage System built by w w 'Address P—lt s01V i .11A L 1 v Consisting of 1��� - Gallon Septic Tank and MC2 L Water Supply: Public Supply From Address or: yr Private Supply Drilled by . -M W � AA 1140. W1Address 8991&bTM :.m d Building Type Rr�✓ i olri �r� Hits Erosion Control Been Completed? - Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises.were constructed essentially as shown on the p ns of 'completed work ( copies of which are attached), and in accordance with -the standards, rules and regulations, in ac ance with t i. d.p n d he permit issued by the Putnam County Department Of Health. Date Certified b P.EsL” R.A. AddressX i!{'� Il o me No. 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 subjeet to modification or change when, in the judgment of the Commissioner of Health, uch r ocatlon modification or change Is necessary. Date PUTNAM COUN`t'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES V1,L-t, �Vyt Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type I R�1 I .0 1 seetlen- -r Block Lot j�: �--T) N Cy Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE 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 immediately following the date of approval of the .. ".Certificate of Const- ruction :_.Compliance ',..for- -the sewage disposal systen,..or_any::__:._ _ .._.._ repairs made by me to such system rexcept w�ier'e`ttie' failure" o f5p at �'" properly is-" r 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 j day of j 19 (5 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature \� Title, Corporation Name (if Corp.) ess COtJfJTY OFFICC OUILDINC • CAnMEL, NEW YOns This report is- to' be iompleted by well driller and submitted to County +lcalth Department together with laboratory report of •naly :i: of water ;ample indicating water is of Sati :factory bacterial ouallty before eertl(ic a of eon:truetion compliance is issuccl. REPORT ffUST 111E S1.111MITTED WITHIN 30 DAYS OF VTLL COMPLETION tlsrPt[R •,illiam Elting 24 Reading Road, Putnam Lake, Patterson, iIY F WION l r(El /MO. � 31.eet) (7C�AJ (LOt /9r/r.oer/ Ballvhack 'Road Patterson �,Tew York - • )POSED slot DOMESTIC ESIAtI SHMENT WA D TEST WELL Public Alit Oiv+ $U? P,y D INDUSTtIAL D CONDITIONING (i ►) .ILLIHG IIPK.EtIT COMPRESSED CADLP OTHER ED ROTARY AIR P;Rr.USSION D PERCUSSION (So +uf�l• :TAILS lING!n rye91j I 20 ::IAKt114lrnc rest 6 W Ml Pit LOOT I 19 I CD THREADED D WELDED U1:1vt LA G � cJ 7 ;jc X §S ` _I NO J TES U NO ( 1EID LEST HOW.$ G.P.M. I YILLD f1 5. 5 LJ LAILED D PUMPED L'= COMPRESSED AIR t Q ?5 'ATER EvEL leLA4UR; PROM LAND SURfACF— SIAIIC(.roMdPbel) 35 - OURt/:G TUL0 7131 Ieeq � 300 . Depth of Co.npleled well In feel below land 9vrioze: 300 :LF[►( MADE L NGTM OPLS %) AG:+11`Ei lttel/ ';ALL SIGt 5:�: j IPACKED: 01"LIIR (JncnetJ I IF GRAVEL ` Won.eter of well ;nclwding I pro-el pock (rn:.." GILAYEL S:IE /rncne3ll1101A 110911 TO floor) 'tQK 1A >:D S'JtlAt!1 FORMATION DESCRI7T10N . iR a FEET � two po t *rACf loconon e) we it arm arsuncet. 10 of a0u two porrt:anonr lonam9ret. 0 10• ( Jilt & COiJ7lese -Dwe I1lln d 300 L -lard ~-rani te. 1 If r ;91cl w01 ttrrrd of o.nr.onl dettrM d..r "o drill:na, 1.11 be;*- t[it GAttONs rtR MINUTE 300 5 }wa..dQ ,3l�•g�t10 � tj/,�zE.3o'1•�c�ns I.�t: 1 1 +tir Mild ��Lli1NaJ, 1) Vl� a BREWSTER (LABORATORIES Box 224 - . BREVUSTER,..N.Y...M1 (914) 225 -2072 - WATER ANALYSIS REPORT SAMPLE NO. 6034 - SOURCE: liJilliam Elting :^Fell Eallyhack Ed. Patterson, NY COLLECTED: December 31, 1925 BY: P,_ill Drilling, Tnc . 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. i .January 6, 1986 Roy Bickwit P.E. Director PUTNAM COUNTY .DEPARTMENT OF HEALTH. ENGINEER TO PROVIDE PERMIT # -� ON CERTj.FICAT OF OMP IANC I Division of Environmental Health Services, Carmel 'N. Y. 10512. ` RERMIT-' CONSTR CTION / PERMIIT_ FOR SEWAGE DISPOSAL SYSTEM 17-- . Locared at•.�� f' 4 L7G� Q JJ �f Block o r village tot v Taz Map Town o la Subdivision -�. 1.._.. subd. Lot M Renewal _❑ Revision Owner /Address n Date of Previous Approval - Building Type R47�-< �� ,V / 'Z�A .% Lot Area % • IG�+ L Fill Section Only ❑ Number of Bedrooms Design.Flow G /P /D 6 ©� P.C. HssltD. Notification Required // ^/ Separate Sewerage System to consist of vo Gal. Septic Tank and U / ��w' r , Cfd�l To be constructed by —T P.0 . Address Water Supply: °° /Public Supply From Private Supply to be drilled by 7 ' Address Other Requirements I represent that I am wholly and completely. responsible for the design and location of the proposed system($); 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 and regu a ions o e u nam County Department of ;Health, and that on,cd- inpletion thereof a "Certificate of Construction Compliance" satisfactory to the Commisstone► of Healthwill be submitted to the Department, .and. a .written guarantee will be furnished the owner, fits ` 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 two (2) years immediately following thedate of the issu- ance of the approval of the -Certificate of Construction Compliance of the original system- or any repairs thereto; 2) that t drilled well described above Will be located at shown on the approved plan and that said well will be'installed` in accordance with the stan ards, rules r u aeons of the Putnam County Department of Health. Date ° . .+. Signed _ f . / p.E. R.A. Address APPROVED FOR CONSTRUCTION: This approval expires one year from the .date issued unless. construction of the building has been undertaken and is revocable for cause or may be amended or modified when co id ad necessary'by the 'Comm' r ealth. Any change or alteration of construction requires' a new permit.Appro =ed f4r�osal 'of domesti 'sa ' ary wage, a' d /or priv a i er only. i ..� (L��j 1� Date _T_ Byr"�^ Title Rev. 6/85 puTNAM COUNTY DEPARTMIIU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS - - - . INSPEC'T'ION ::REPORT = - - -- j + DATE: - , 1 S' i ✓� {� I 1 YlL� - INSP. BY: (Name of Owner) ( Street Locati on) INITIAL SITE INSPECTION YES t NOI COMMENTS 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 Descriptic 0 ft. �- 3 ft. 6 ft. 9 ft. - 12 ft.1 D. H. -Deep Hole G.W. - Groundwater D. H. 2 Lot D. H. 3 Lot Depth to G.W. Depth to G.W. Depth to rock Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft: 0 ft., 3 ft. 6 ft. 9 ft. 12-:ft. Soil Descripti< PO a DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan....,. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Rom allowed for expansion trenches........ ... X� x' Over 100 ft. from watercourse .................... IC roJ --f­)'--)6') < e r 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. fron nearest trench ................ .�- 15 ft. of peripheral soil horizontally fron trench ..... ............................... Boxes properly set.. . ..... ................... Could surface runofffron driveway, roads, ground surface, etc., channel near -SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. .. Q 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 !/' i�J G Address /f Located at (Street �ndicAte �1tcs� - �'- / Block 1 Lot nearest cross street) Municipality, Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION RM 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 zz 17 . 2 L a Z. —r 5 2 1 0•` L 7/ czo F 3 g 5 �'t� 3L) �?21 Z 3 _` O 1 2 �, n 3 4 i. 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. DEPTH G.L. 6" 12" 18" 24" 30" 36" 42" 48" 54" 60" 66" 72" 78'► 8411 � ,... INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �.a 4"�`F�.v7'� . INDICATE-LEVEL_TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE ELY -Z� , �� _: .... Date a /-x f DESIGN Soil Rate Used f_ --V n/l Drop: S.D. Usable Area Pr ided ti O F N '�,, No. of Bedrooms -3 Septic Tank Capacity Absorption Area Prided By__ Sr L.F.x24" g A5 wi c . o Ot _ a .> TEST PIT DATA REQUIRED TO BE_SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. J HOLE NO. HOLE NO. „~ ,1 �r Address THIS SPACE FOR USE BY HEALTH DEPARTP-'NT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date NAS60CAAT�S,?C-, PAT6P' TAW K 1000 CPAL, MAGNO,-SPTIC TAr. K 315 1. .F � 2�F" Tt2��G1°1 - _______..._._ #�_. � 40' 2;� -. �. y�' -�`� .. iN5"fD.l,l. -� ; -- -___ - -�3 -V 4tv-O� too' -� ,r 1-7-SO &A[, MAcz,01,1; Y 60-PTIC, TAWr, 04 Lfi ,515 L IA" 70NC-ti A e9 , " �7 -10 LR T14 F I AS 15U10 5CW7 1C, 5Y57W WIWAM e%,-TINCa WT No 2 F/VN N,9 2ZIOS 70 01- 1- 1.1 5ALj,,YHA(,K I�OAD fttnam County Department of Health .17ision of Environmental Health Service.. 7OWN Of IPA7�QSG)� :,proved as noted for conformance with :4� - ilicable Rules and Regulations of the 'fU7NAAA CO. .1itnam County Health Department. of N�k, 0 7,4'6b