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HomeMy WebLinkAbout1853DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -41 BOX 17 01853 Iml 6 On 1. 0 FEW EL L: I ol ' IN 01853 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION POF* ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN TA SHEET- EPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ,�c�� Address Located at ( Street ���� taw Sec. Block Lot -- � ndica e nearest cross street) Municipalit�ir� Watershed c Y- r SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED - ITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION 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 2 3 30', 2 3 4 5 1 2 3 4 Notes: 1) Tests 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 :...:_:.:.a ... .... .:. ....:.. DESCRIPTION OF SOILS -=ENC OUN`TERED....IN -TEST- HOLES - 4 DEPTH HOLE NO. / HOLE NO. > HOLE NO. - — G.L. 6" 121.. 1811 � _ 1 241 3011 S 1,N1 3611 �-u C j 4211 48" 5411 6011 66" 7211 7811 84" 1 / .� 4V I a .. :..... INDICATE.-LEVEL AT..WHICH..G ' "U / WAT aR . IS.. ENCOUNTERED ".."' v _ ...:_ ;,' (: ;;"- rte.:.. -.:. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date L i DESIGN Soil Rate Used Mir�/1 "Drop:. S.D. UsaUle Area Provided c�c 0 No. of Bedrooms j Septic Tank Capacity �7 Gals Type -G,,�L.F.x2411 T Absorption Area Provided By. jb"— E% width trench. Other �ltlli ►1 '�� ell Name Signature Address SEAL = ;;Q`` yAG'•, ,� • 4i. Y�Y L• L, ' Ln THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: ' ?,, PE Soil Rate Approved Sq. Ft/,Cal,. Checked by 1a ete 1 Owner or RIrchaser of building MunidipalJty Building Constructed by 1 ljo Block Building Type Section 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 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 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 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 c_aused..by_ the will fuln -or-- ieglig.en.t _ac t__of_.th�.._accupant _of .the ..building:: �atilizing_..the- ,e a system. Dated this day of alte 1973 Signature �. Title (if corporation, 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 3 E- ci -Im Ij 10 '4:7 APPROVED OF'Nt� S, 104//*ZT �V, 04 . . ........ . ALIR si, "-� 76i Coi� W& OF ENVIRONMENTAL HEALTH SUNIC0 4-,7 A/ -7 - - -� o- -- _ � PUTNAM COUNTY DEPARTME HEALTH, x` -- r = ` Drvttision of Environmenia/ , .T. Health Services Carme/ N '� MY 10512 1 f .: :, ,�. 1:i '� -4 -}S < - f I �, L l tb '' E p L i _k �t h+s''v i"k,", , f 'I ti � CONSTRUCTION PERMIT FOR SEJNAGE DISPOSAL i SYSTEMY i Locaied at +'�iyiZ£ 1 S�G�,:_ � iIC v Town or ,Village ° l �` ..� 11 < 1. Section B IOC kr Subdivision 6. ���°�� V3'Fi l Nib Q ©G u7 �� Lot Job Owner �.4> �r� 1J Iti i_ �' t / a l" `,, ill Address �� 1 -a r, U t } Building ��l�v�� 1 � t�i' �, ;Type i' Lot Area ?" CtiC9Fi t W hti_ �b i �s -� Number of Bedrooms t4 f J.s - •-1 .- Total Habitable Space ,�is" Square Feet. Separate .Sewerage Systern to consist of - U% :} a. I N V ff , ` 11 '•?��� Gal Septic Tank Imeal feet X .� ��_ width +trench e 4. To be constructed by VCe,,t :: fi W. Address t/'J ,�Ly4L��- - -� Water Supply ,Public Supply Flom ,Supply to '-b- e drilled by t _Private Address .j 1 >; 4 Other Requirements <:, a. :.. ... , . ., 'I represent that t am wholly and completely_'resp. ns, for the des,g "n'andlocat,on ` ' -_ - ' ,1e the o'o P P sed ;ystem(s) = that the separate sewage disposal, system , above described' will be 11 cohstructed:as sh'own`ion tpe,apo vv,6 -- - erinn;i,.r -rtio ......a :_ ____ .__ __ w• w!a sewage, disposal system during a Wl of'the approval of tI Cert!f,— . 0 , Constru'ction �ComplJance of the ong,na 11. will be located as shown on the approved plan and that said well will - ":installed m' ' County Department of Health #• c ry p 4 C, Sy t } a { sy r C) Deter o r Sig 1. Address r ' APPROVED FOR CONSTRUCTION Ths -v pproval'exp:res one year from the date ii r "vocable for cause.or may ;be amended or modrf�ed when considers 'f r' e-e- b regwres a ':new erm�t A Y E P pproved .for d sposal of domestic San yrse ge; a {: Date By M.. ..�.. � '; AJeSSa7au s� e6ueyq ao_,uoile?!)IPow uo!leao ^eJ yons�y3�leaH to J� o sslwwo� aq le• steno.ldde, ydn5, 'alQellene�. saiuo?aq Rlddns Ja3eM ,51IQnd 'e11uayM ;p on pue:jlnu auai awo3eq James ­­ CJel!ues �!lgnd;e_ "se uoos se pion:,,pue.Ilnu`,awooag; pet's- uia,__4 '..d Uaoma 1 e CJel�uesun �CUe ;o uoitdaJJOa ayl PJno�•ol fuels /a�ga�uLe�q Row se uo�l a ydns ailel RI3 1 1! oN asuaoi-1 YrIJTi' Ei Ir 9 3� f 111? ) kq peg ;�lJ; o uau JedaO sC3unoD. weul ayl �Q� Penssr.liwJadsa P -'P POMP sueld s99!! y11eaH : 3 ¢� uassa pal�nJ3s6b? . iii , aJe yolym ;6:,s eldoo) �IaoM palaldwoo 0y3 ;o sue- a- uo u -I . k &mss' � a .. l 4 panss9 liwJed;`ale0 suaooJPa9 > ;o�oN. " li S s - -'£ 4Y S ( 1 � ai' � ;y d -S 1, 4 -w Y' etil , X aad I¢ gDUaJl 43Pf^.< ,s� P P s y } ' ''1 l0 z of q � )1301a u- -i r 11 . - ;a•: e6elp/�,do umol" ', r °c �" (/ ' � W31SJlS IsHSOd514 ;3JVN13S, a :' 21501. "N ; laluiej 'saoui�, yi'/ "all 1p H1,1VAH -_ 30 LIB awlL I d Q . As 1. u r � s 1 -.! vS a x 11 11 _ - - f . '- :t r �` c 1 1. -- _�..._ -- - ce' , the` standar rules "and r 11 egula't ons of the Putnam - c s - tti P;E �R.A. J dd , :. �jj ` License No "T �o w 4 un onsfruction -of the building: has beamundertakenandJis. ' er of Health, Any change or alteration of construction- - ter ly 1. only �' -" { ra a ,. y 0 �1 T Ifle i ,; F �r - - ualiloPnl *dos — - .AAne � �in;,,i; QAlJd: aUl ^JO �lenoaoae- ,ova -r �SJwdJana v� + e i ss �J _ . . } b ^ i6aJ Pue seln�a sPJePue�sEe43 U3!M aouepao�ae ui, =pue (Pa4oell, wnJas Pals!1 se (s)we1s -11 ayl ! .. X-! ,_� I MS..,.. eJ ­-- -­ "6,, .. < - -. - -- 'id - �,� I.palaldwo� uaeg loJ3uo3 uo�soJ3 se! I ad�Cl 6ulPh! 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