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Home My WebLink About1878DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.05 -1 -4 BOX 17 ol ' '+I T � . 1.6 LNO L r ' N : I IN .0 90 * .� , Subdivision / Lot Jobe ok 4 Qwner V A Bu�ldin9 :TYpe Jf �i.' f f Lot Area G G9 f Number of, Bedrooms:: Total Habitable Space Square',Feet; Separate,Sewerage;System -to .consist of ;.' -Gal Septic .Tank lineal feet X width, trench _ r _ el - Ta tie constructed by ` _ ./ �� Address " Water SuPPIy. Public SuPP1Y From Private Supply to be drilled by : t� f f Address Other Re9wreme'nts I represent that "Tam wholly and completely rasponsiblefor,thedesign; and location of the proposed,system(s) i1) that,the,rseparate sew age ,disposaf';system .' above described 'will be- constructed as shown on'. eapproJed. amendment there to and. in accordance with the.standards; rulesan .regu a ions of--he u nam County Department of',' Health,; and that on completwn - thereof a "Certificate . of, Construction Compliance',';satI sfactory,to the Commissioner of Health will , be submitted' to the Department, :'and a written` guarantee ",will will the owner his successors heirs or assigns by the:build`er that said; builder Will place in good .operating - cond�tionrany part of Said sewage` d�sposel system during _the period of two-( years immediately .following,thedate'of. the issu ance`.of the approval`of` the Certificate of Coristruct�on Compliance of -tlie original, system or any repairs thereto;1 hzit'the4rilled';well descrJbed.;;above Will be; located as"shown.on the app[oved plan and:,that said•Well will be, installed m accordance ;.Wit standards ules_ and ;regula— off 'tFie • Putnam County Department of Health. Date. 1 Signed P it Fj ij Address 1 7r _ *' i I cense No. APPROVED' FOR CONSTRUCTION: This rov I ex ires:',one pp p year from the date •iss�ed unless constructi o Vy building has been undertaken and is revocable for cause or'may be amended or modified when considered necessary by the Commissionei of'Health ; change- or! 'aiteration of construction. >.regCiires`a new permit. ;:Approved for disposal¢of.'domestic sa it ary sew 'e; an r,pr� err supply only / Date /� By Title m /6,77 Q�4E3.o$' La7 I Q Z6 A JI e 1 c, n' Fi k'FA _ U. ys � jar s/te ;,C 0y GqQ. IfQ 1 7 NA ' n V kts:v'c,E �•:^�. X 1 1 � 3 r u1 a Watt .fore ! . +w.At .. f '1 MA HQ e.' .f q / PLAN - JUNCTION BOX MIN.i2 *19" N, r' . b i { ELI 1 L . i 'MIN. .i • ' - S {Z�stoeN.cE.. r CAST IRON •' . 41NIITARY T£ i Gz> SECTION Dlsjr ai1OoN ge.PTic I TYPICAL CONIC. PRE CAST: gefG I F. ANK SEPTIC TANK. �, 'HFiNF 6 c,L 8tW i EARIH 1 v y, •�OtT F- aACHFILL °' 401 NT F y BI.OG.PAP'ER ITJuNC isaFt .P—s fto4pJ7 5A'(• 'P4k,Low fRCts•('.'LI>IE.. e. OR HAY 11A -ffl'L 1--5 �(o wM(eu Sir,- 1-AM- MArzs4- LA,IcT PAtF_c b c. 46E. aAA 10.4 'n A a4-I.�- 5WO , m l E any � Draw(- C 4 . " { {- r 24 "MIN ___,._ Lt AN OCtkVTH4 C:$s- .. 1 ..+r.,iaVAAPshl, -. , � f'° ---' 'i CRUSHFO 4 Aj-L L.4weAt, jR�..E . wg4itl. to oi: .Dtv osa L v ABSORPTION DRENCH' x' /wMA-1 A 10 Pa t;, , (= f- m c, t t- r,, , P r f �ED . APP SYSTEM TO BE CONSTRUCTED IN ACCORDANCE WITH•TIj3E Rt' �'A ; . REGULATIONS OF THE IPUinIAM COUNTY Dk�PAi2fi�!~RtT OF HEALTH. ' w t s lJ SYSTEM SHALL NOT BE BACKFILLED UNTIL INSPEGT.EQ 4� MAY30.1974 ENGINEER AND rHE LOCAL HEALTH DEPARTMENT 1FI- RIit"31I f3 SYSTEM TO CONSIST Ot A 90o GALLON 3 Fil K NTri un i. Of�SEALAI AND 24�_FT. CAF __,Zt__•,FT. TRF N CH WITH it < =�A3 klt'I �o �r esr PITCH OF Irir' PER FOOT, otwsioMOT DISPOSAL SYSTEM GRADES REFERFNCFD ;,, , MYIROnAtRITAI'nEALM ftiVlr Fl. d-OR E L E VA T I ON UNLESS OTHERW 1SE NOT l . s. S.S.D. SYSTEM FOR �• �I A R -E.L� r3 R.n,ip REVISIONS HOWARD A. KELLY, J.R MAfy'rN7...14 e�` A. (C ASSOCIATES_ Lol q o �o c<<. .,o okre oh' CARMEL. NEW iGRK {' 11-26.73 1'( TAX M4f5 N0. r.,$ BLK.NU '.� 'i:.I`''`L Pry'. 3 yn ah �n 2 �w TOWN OF PA. tF F.tb0Pi er a s, .38998 �r� .y 4Lhktl I)vte t � ,t'1lI t3 Yrr,ow 6 40, n r:. a r, t 6 PUTNAM COUNTY DEPARTMENT OF HEALTH J DIVISION OF ENVIRONMENTAL HEALTH SERVICES . _ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 1,p Addresses Located at ( Street ��l P� �C CD-Sec. CoS Block Lot ��n rest cross s ree Municipality 941gwS,00 Watershed C&Tok) SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse 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 1 2 105� 106 I'D �7 1 3 1 45, 2j 10!1 3 4 5 1 2 3 4 5 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" 1811 24' " 30" 3" ' 6 `t2" 48" 54 60" 66" 72" 78" 8411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ,T.,T T " "' q HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTE BEING ENCOUNTERED TESTS MADE BY Date DESIGN._.. Soil Rate Used Mirl "Drop: S. D. Usable Area Provided S � No. of Bedrooms Septic Tank Capacity Gals Absorption Area Provided By�l ,%� L.F.x24" enc . Address THIS SPACE FOR USE BY Soil Rate Approved ure SEAL`I 13 DEPARTPENT ONLY: Sq. Ft /Gal. Checked by \ofi NF`s', // Date b r PUTNAM COUNTY DEPARTMENT OF, HEALTH Division of Envvonmental Health Services, Carmel,N Y 10512 CONSTRUCTION PERMIT FOR SEWAGE DISP SAL SYSTEM : PAI / t"rLSa z n or Village L,ocated`�at ••_ Sectron �y ,. Block Subdivision °►'S Job3 of -�, -.- Owner N`' � At2 0 Address _ /1 Yl7Oc9O (� iI Buildirig •TYpe � C�\ Lot Area Number 'of Bedrooms Total Habitable Space Z- ©y Squaie Feet - Separate: Sewerage System to consist of:.� Gal S,ept,c Tank ZQ�7 hrieal feet .X width trench I To be .constructed by %i3 `Qter, AA (!J� Address i Water Supply Publ�c'Supply_ From v i —77y /"JLs D E-TJ M 1 Al �"1n. • l.. iPrrvate`Supply to be drilled by.. - Andress .5 . Other. Requirements - _ - sstem 1 represent that I •am wholly and completely responsible for';the design and aocation 'of, the proposed •system( ;) 1) that the separate sewage_ disposal y above de'scribe'd will be constructed as shown on .the approvetl amendfnent-there ' to and in accordance with the standards, rules an , r -egu a ionsp e u nam County . Oepartment of Health,;;and that on:completion thereofi "Certificate = of Construction :Co-mpliance ".satisfactory to the Commissioner of Healttimill 'be submitted to the Department, and a: written guarantee will:,be furnished the owner his wccesors heirs or assign's by ftie. builder; that -said builder will „ it : -. place. m :gootl, operating contli tion ariy part of said sewage disposal system during the period of two (2p years immediately• following thedatii of. the issu- i ance; of the approvaI:,gf the Certificate, of Construction: C6mPiiance of .the origiral systel.oraany repairs fheret6p�2),'that the- drtiled' well descitted,above will be ,located as: "shown.on the approved :plan and`that said well will be In"Aa0e m accordance with .•the standards rules and regula rqR of the Putnam County Depart• nt o". ealth Date - �'a 5� .P E Q-A r ^t. r Address �' License No. i APPROVED FOR CONSTRUCTION This,approgal )ipires.one year frori the date• issued unless 'constructio the building has been- undertaken and k revocable-,for. or-may be amended ,or, modified when`cons�deretl necessary by •the Commissioner of Health Any change or alteration•.of- construction . requires; a new permit ` rovetl for disposal of domestic sane a`ry sewage nd /or pnvafe ater - supply only s Date / 1/ 3 BY Title m . REVIEW` CHECK SM] Meet td`a Re `arks �9WARD AXELLY, RJR es ,�Asoe ATrr o ' .DOCUMENTS eaoM AA - `House plans 0. K... Design: data .sheet Peres presoaked?*,, Min'. 30 ". pert test depth Const. results,for 3 runs I D. Hole log O.K. ; Corporate Affidavit for other than individual i Authorization for engineer. I Letter. � from ,Water. Supply if. applicable If ;variance requested - such rioted oft plans &apps . DETAILS f if change., is proposed, ) Exi brig. contours shown. show new contours) Slopes for driveway cuts.., 'etc. shown , 1, :...Water service =lin.e. location Footing drain, etc.. location Top slope, . bottom slope of fill . Percolation tests and - :deep test pit location.,: ° Sept- c�.tank size and. conformance to '. std.: -3 .B. Ro . house minimum. .. . ouse setback shown ! 1►7V1'1.UL141V11"IJl / h.. ftg...._U.Ci1VW...1.rost,.,'. :..:,_..; -. 7.., .•.:.'.. t ' .. .. 1 _._l_..a..z -,.: ... 1 water within 50 ft . -of .PL .shown I Plan and.' profile SDS . All `other we _and S 00 DS closer ' . 4� { Shown or reference--made------- .._..._ : I Pro perty..boundaries (metes and bounds - clearly .shown ' SEPARATION -DISTANCES, SPECIFIED. ON . PId 10' to P.Lo _:20'1 to Foundation wa •ls 300' to.,Nearest well �.. 54' to :�tream9 march, ;lake;,: etc . inc e expansion , .151 to Curtain drain i .- 30! . to water li1i6-.-_(pi s 20 ! _ 15 to storm drain OA 101 to•large,-.trees 1 0 from- foundation to septic `:tank a 15' to ,:pipe from..leader drain...& foo ng rain � * 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 AM Address — rj4c)QN0jtL)fa Located at (Street Sec. Block a Lot 57-4$5., n ca e ea es cross street) Municipality ��-j -j 2R6L) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to.Water Water Le ve No. Time From Ground Surface.in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 22;3$ 2 41 `1 1 js 1 .711 32'• 7-1 Z'• 'L* 4�:5"1 53'o$ b °. 2v IZ Izh 21).52 t4¢..__ iZ 19 3 f 4 5 1 Notes: 1) Td'pts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES D2PTH H0 NO. HOLE NO. HOLE NO. G.L. 6" 1211 1811 2411 3011 3611 42" 4811 41C 5411 6011 6611 7211 7811 8411 INDICATE L AT WHICH GROUND WATER IS ENCOUNTERED Soil Rate Used 11-1 ( b1im/l"Drop: S.D. Usable Area Provided .No. of Bedrooms Septic Tank Capacity 900 -Gal Absorption Area Provided By_.��L-F-x24" 5b dtt\L! -te ch. Address Z) griatiaTre, tt 4 .1 N SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by, Date __...1._.._... I s. ��. 1�Oi!Os :l:A� urn tt� AtA Fal di E•,s�Q� i{ A L i ,.� 1 11 K 11 e y , x y,. l o ,t %I b i t - 4, V �- +,..•........_w v.....:. le 77 at Lmo. '011A ANHOIt- COVE. PLAN JU1141-1 )VIN OVA MIN, J2" • 4" IN 4'.M;N 3 MIN F- t4c Q;— SECTI ON 3ANITAWr Trf -- TYPICAL CONC. CUNC k"D 1ARY SEPTIC TANK kFINF S"C,,: R/W t c CD. 4 $t. k.*A AAA-1 I c — GRD. LEVEL EARTH tft .34'1 13L Do -Ap-R I' OR H.l. ;4 P ~C W, I'- A, P,'.,T 1, DI t T'k 5:5,.o Lr,&vp- R, ✓,14o o(- A. T�"LE� ekT41-i 10' 'Of Di15?0s" A83QRPT0t4 R E. INCH, N f) TE: S (s-f Em -ro BE (ON!, I RuCl ED IN ACCT -l'( WITH-IT411F RULH- rl A NO R9GUATI0NS '-',F THE U'l t-.l A AA COUNTY �DEPAR. r-MENT APPRI OF HEALTH. STEM SHAt.1- NOT BE BACKFILI.Lct) UNTIt, INSPECTLD BY DFSJGN EN(,INEFR AND THE LOCAL HEALTH DEPARTIArNT IF REQUiRED. S E P i 15 7 SY!;IEM TO CUNCdLT Or: A t)0c _(-,ALI N SEPTIC TANK AND-I�L(2-FT. qF 3-.--FT TRFITICH WITH AMAXIMIUM PITCH OF 11jr' PER 1`00T. VTf4AM COUN olvislaiK��-( DIS110SAL SYSTEM GRAPES REFERENrE.0 TO Fi : N'IcHEL' FiFiST FLOOR ELEVATION UNLESS OT!4EPW!SF NC)TF-6. S.S.D. SYSTEM HOWARD A. KELLY, JR. +Jc, '51G 0. NO DATE BY ASSOCIATES -F L . N- W YgRK CAIRM Q AQ I TA Y f A rj Nn !_Q at V hjn 7 IrYPUf x I e TOWN IF PAJ L 92 SO Q 4 u Ap;.d 4. ZAJ I Ll D p " 4/4 7 /0 t & "5' Lmo. '011A ANHOIt- COVE. PLAN JU1141-1 )VIN OVA MIN, J2" • 4" IN 4'.M;N 3 MIN F- t4c Q;— SECTI ON 3ANITAWr Trf -- TYPICAL CONC. CUNC k"D 1ARY SEPTIC TANK kFINF S"C,,: R/W t c CD. 4 $t. k.*A AAA-1 I c — GRD. LEVEL EARTH tft .34'1 13L Do -Ap-R I' OR H.l. ;4 P ~C W, I'- A, P,'.,T 1, DI t T'k 5:5,.o Lr,&vp- R, ✓,14o o(- A. T�"LE� ekT41-i 10' 'Of Di15?0s" A83QRPT0t4 R E. INCH, N f) TE: S (s-f Em -ro BE (ON!, I RuCl ED IN ACCT -l'( WITH-IT411F RULH- rl A NO R9GUATI0NS '-',F THE U'l t-.l A AA COUNTY �DEPAR. r-MENT APPRI OF HEALTH. STEM SHAt.1- NOT BE BACKFILI.Lct) UNTIt, INSPECTLD BY DFSJGN EN(,INEFR AND THE LOCAL HEALTH DEPARTIArNT IF REQUiRED. S E P i 15 7 SY!;IEM TO CUNCdLT Or: A t)0c _(-,ALI N SEPTIC TANK AND-I�L(2-FT. qF 3-.--FT TRFITICH WITH AMAXIMIUM PITCH OF 11jr' PER 1`00T. VTf4AM COUN olvislaiK��-( DIS110SAL SYSTEM GRAPES REFERENrE.0 TO Fi : N'IcHEL' FiFiST FLOOR ELEVATION UNLESS OT!4EPW!SF NC)TF-6. S.S.D. SYSTEM HOWARD A. KELLY, JR. +Jc, '51G 0. NO DATE BY ASSOCIATES -F L . N- W YgRK CAIRM Q AQ I TA Y f A rj Nn !_Q at V hjn 7 IrYPUf x I e TOWN IF PAJ L 92 SO Q 4 u Ap;.d 4. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES S NAME /n PHONE X-W-6-s-- yl-s- SITE I=TION AA' 44(14-YU� d4, v TM .5 MAILING ADDRESS PERSON INTERVIEWED PaD CaTiplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER PHONE REGISTRATION # Proposal (include sketch locating all adjacent wells): Nam: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal 2. 211�115VA% WIN W-4 F-A 1 M NO Inspector's Signature & Title with the following condi Procurement of any Town permit, if a Submission of as built repair sketch a. Owner's name. b. Site Street Name, Town and Tax duplicate showing: Map number. c. Location of installed components tied to two d. System description (e.g., 1250 gal. concrete drywells surrounded by one foot + gravel). fixed points (e.g.,house corners). septic tank, three precast 61 diam. x 61 deep e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE TITIff2— DATE W 7 OPUS: Mite (PCHD); Yel1cw (Ttun 131); Pink (ArPlicEmt) 171 C- J71 < C) fixed points (e.g.,house corners). septic tank, three precast 61 diam. x 61 deep e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE TITIff2— DATE W 7 OPUS: Mite (PCHD); Yel1cw (Ttun 131); Pink (ArPlicEmt) I lb torbs" 0 PLI CE/ V D Cou; ,Ty f9 S Aug 21 pil 07 a&-o Aof-r, F--1 asp '4m W45t<- (Y7 Ye 74 X02E- AS, pl,"-72619 00 y ifi Z #�� , -Eu m��.