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HomeMy WebLinkAbout2138DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -18 BOX 19 1 rm I ' .' mg '�~ Z, )l r l r� L J - -I ' ■ r Ih{'� T L! Ir I6 02138 e6 �' K PUTNAM ,COUN'I'l a ' D .of Environme T ,.;, r,.'+• Y v a � n '• d •r aT x-cFM'+f'^S"`' Located at vowOWOer /Formerly Separate Sewerage System bunt by ' .,i �1 hit s A• Consisting of, . Gal Sept lc T ts �nk and L Other requiremen ti Water'.Suply ip , Public •Supply Fiom /Private 'SuPDIY Grilled 9y • • t � Adtlres3 ° .,... } S' Building 'TYpe Ni . i Has Erosion Control B SOW, ompletedt ti rI certify that he syetem(s) ae,lieted serving. the abope;premiaes were. -of which are attached) ;'and in .accordance with the standards `ruieswand' ;Putnam Countp,De rtment Of Health 4 f •� Date U 7,1 Certified µby Address ' e. � + + r C,: -. '` t, •�a �t 1r c t $ r t. ,ra•;i .4 �� `�t.S y.. Any person occupying premises served by the above systems) shall {prompt) conditions resulting from suC.n14 0 i ^Approval of,the-�separate'sswera avallbbls_and t:ha.•'approval of the,;privato ovate %,supply shall becomenull an subject to modification or change when, in`the 9udgment`of the Oem[ni . 9 Date � t r BY Rev. 9-61'- - - K A RT MENT OF, HEALTH �F i L � 1 � � 3E. DISPOSAL`: SYSTEM v rYi"N A, '` Y. L. : Town or: Village •raxMap 'Block " Tax Map Lot iil v � i Bubd rLOt 8 � IF } h , ti n:e ti r .i 'of Bediooms N �: Date PernNt Issued t. F netructed essentially ae shown on the plena of the complete8 work (copies equletiona �'in accordance with 'the filed plan; d the "p@rmiY iseued'by the K ' F ✓. nsi No.E R A eke Each action is may De neessrary,to are the'vorreetion-,of any unsanttary ystem ishall become null and void'as (soon is a Public` sanitary ewer. becomes void whop a PuDlic�,w pply becomes avallablL.' Such :approvals; ere S i o r of• "Health;suc evowt{o enodifleitlon or ;Chang ls�mc�ry - TitN + y1 1 Owner oz urc aser of Building . Section Building Constructed by Block��, Location - Street Lot- Municipality l'.yn Ce/1 "L4 Building Type Subdivision Name Subdve Lot ## GUARANTEE 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 guarantee to the owner, his success - ors, 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 determin- at oYi` of i ki-6- -`i�irootor- uf- the Divi's'ion- f- Environmentai -He'al-th Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system Dated this G day of 19.E V Signature Title Corporation Name if corps 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 t PUTNAA� COUNTY DEPARTMENT OF HEALTH - ' w Divisi n .of Envtronmenta'l Heal 4 x m 4 n r «< es Carel' 10512 t .max } 4 ' •r � Y- - - =- CONSTRUCtcI •N P,, ERMIT ,FOR_SEWAGE'DISPOSAL,'SYSTEM': -.1 own orAillage a Located At ?l=k .�. ! 1 G1 ►`�a�� _ - . :lt� T _ Sa P # w sulxY 1 Subdivision Lot #,` .� Buildrn9 'l YPe- "7t17ei'L�4L Lot Area } Namber -of BedrporPs.— sDesign',Flow Tota'rHabdable Space - [� Square :Feet Separate SeWerage'SYstem t Septrc Tahk and�ench -- * pi a' l'o be constructeC by � •'mil" � A� s taGK.� �i..(��� Water Supply Public Supply ,From y -'it'. •� �\ � q4 , ' -, 1 w: � Y � v Private 8upply_to be filled Other Requirements q I represent that -'I am wholly and. completely responsib for the design - \N o ton of the proposed syatem,(s)jAl) that the ee`arate.aewa a dis sal system above de'seribed will be,constructed as ,shownj.on ;tFb approved'attao ents heretoand in' accordance with' the etatidardsy rules an8 regulations of t?le.Piitnam County"Department.:Of Health and ;that on completign thereof a Certificate of Con6truction`,Compliance satafactgry \to the,Commi Sal on =, , er \of Health will be submitted to the'Departmenty and a'writteri guarantee will be,furnistied theowner lii "s aucce'esora, heirs or assigns by the build-, er ttiat,,:$aid liuilder will place'in ^good operating condition agy.part of; said sewage disposal system during the' iod_of two (2) years immediately , following tha data of`the issuance of the approval of.the Certificate of,ConstructioniCompliance ' of th @';origi .T?, atemT.ror any'.repaira;;theretoj ';2)'x „ x:.� :;that the;.dXil)ed well.'described ::; will be located as, shown on the approved plan d t sai well' 11 in to leii;'in accordance with the Stan- Garda rules and re lations €the Putriam County Department Date Si9nep, P.E. b 7 c Address ��6�'c6NATFW &Tlb'4`TfiiS approval expves= i from the date_ issued unless onstructionilding: has been underataken and is _ revocable for cause or may be amended or,modrfied wh ons�der `neces X bythe mmissrortertof Heplth Any,; change; or`alte►afion'iof• construction ,T 7equ�►e4:a new .permit i Approver! for drfposal of cries dart's a p a water supply only Date :vIp (� 7' •; S '• itle ` ^f I INIT.'rAL SITE TDISPEMIO'? 'es No Cormcrits Property lines or corne-r3 found o G e o O V. Can estimate hour^ lac_U on . . . . ..e . e . . Will driveway need cut hrast trees be romov�_,d -note these Is deep hole hepre.en-at'lve of entire SD) area Additional doon holes Sufficient SDS "area airallable considerim; driveway cut, house location, separation / distances, etc. e e o e. . O G e e e e O. e e DEEP HOLE DTI A Depth: Wader eleva,tion:�j on,-c� 0, Rock_ elevaticn: Soils descr_1Y }� . Date: rII��L SITE ri,Spi7CT�01 Ins p. bV: House located where shc: n on approved flan n fj p� T n -- r p � o. 1- �� SDS 1o„�.t.,a �••h:.� e a�p_ .�, �.z e e . e e length of tr nch h aceraa - Wlidth of trenc � Slop:. of the line and trench acceptable • e Room allowed for e i- nsion trench ;s - - Over. FO..ft from] sW11 ap,:1­7 _- ' cou11se . Natur!11 soil not strir_red or SDS area unnecessarily gra:.dea 10 Pi, . maintained fro,] prop.line and 20 ft. from house . . . • . e . . , . e e o Separation of trench f � cm, house, well etc. follo;-rs plan . . . e e . . . e e e e e e Nu►i;ber of bedrooms c1. -c'a e . . e . , e e Stones, brush, stumms, ",;bole, etc. greater Vian 15 ft.. from nearast trench . . e . . e _ " 15 Pc. of peripher' 1 so-J-1 horizontally from 1. trench• • • e • o • • e s e e a e s o e e o ^- Junct; i on boxes prop,,rly, set Coitld Surface . run off f.', -cm dr:ii7cw y, roads, arol."n d sair ace, etc. channel near SDS •. aroL e e o e e o a e o --- - l�a:�s lot car. ai an'.-)Car O.K. in zarca. of SM FINAL GrftDII, ,1G OF SITE ACCE -1-IM 3LE o i I:o: iSn data. sh-Ict -! i Per c3 I.)I'cso III ;d.? I:in. 30" Pere test; dc,, r✓ ?� I — Con.j,t . r�•�ul t s for 3 r. ur.is 5 I ✓ D. Iiolo lo,; O. Y. I` Corporate Af .i.d_1v:it for o::he•r than individual ru I AYior. 'Azc vt ti.on for erii.ilccr_ ! Intter from ?-rater Sunoly i..i' am)].ica.ble i If variance rerluested -such noted on plans 8; apps. d if char,,,._-- is. prcpos� , ) ,in- contours shorn -ksho,r neTr contours) S? op _-s for - driv. v,,ay cuts, etc. shown I l rater. ser•V _ice line location Footir�; drain.,' etc. location i I Top slope, bottom slope of fill 1ercolation tests and deep test nit; location I Septic tank and conformance to. std. _ I 3 B. R house minimum House .setbac ?; shown I I All water wir, n "u I u. . oI• FL 6nown Plan and profile ile SDI .. _......._ �..... �....... _ ... . All other ,-cells and SDS closer 200' shown or r- ference made_ -_ •Rr6perty boundaries (metes and bounds- clearly show j I ^PARATION DISIANC ES SPECIFIED OW PLAN 0' to P. L. 0' to Fo-midat.ion walls � 0' to N- -arest well ! 0' % irarch, lalke, etc. incl . expansion }� . , 5' to Curtain drain - i J' to vatcr line (pits -2l) to storm drain J' to larigo .•t;roes fr0111 fOLMdat;iori to :;cut;:i.c taiik to pip. from larder d.,aj.n i'ooi;i.rj;; J I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION;OF ENVIRONMENTI'L HEALTH SERVICES Da to 'Re: Property :of�� Located at Section Block_ Lot Gentlemen: ' This letter is to authorize a duly-licensed -professional :engine'er or - registered . architect (Indicate) to :apply for a Construction Permit fora separate sewage system; to serve the above noted property in.accordance. with the. standards, rules . or regulations as promulagated bye the Commissioner'of the `Putnam .County `Department of Health, and to.sign.All necessary papers on my behalf in connection with this matter-and '.to supervise 'the ' construction of.said :system or systems in conformity with the provisions of Article 145 or . 1475 Education Law, the Public Health. Law, and the Putnam County .Sani Code - Very truly yo, rs, :.igned Owner o� P'raper Counter. �f ..Address ' _4 .Telephone y Address �0 Telephone L . 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 Address ©c cJ v',, Located at (Street �.� sec. Block Lot ( � n ica e earest cross streeTT Munici lit p� �N �," ` Watershed `rj -- , I Y 1 1 R Le AG M o� Qom+ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME - PERCOLATION PERCOLATION Run elapse Depth to Water Water Eevel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches --Z 3 O TO ! e 19 20 1 'O _7 4 7 C _2 � 1� 2. 3 Notes: 1) Teqts 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_: CRT.P'�UX_0F_.SOI-LS ENCOUNTERED IN.. TEST -11.0 '•: ;.. DEPTH HOLE NO. l HOLE NO. HOLE NO. G.L. 6" 18" ►1 2411 l' 3011 3 6" 1 4211 1� 4811 1'J 5411 6011 � 66 7211 7811 8411 -.... INDICATE LEVEL AT WHICH GROUND-:WATER- IS ^ENCOUNTERED INDICATE 'LEVEL`TO WE CH WATER LE` FI, RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date °7 -1-7 DESIGN Soil. Rate Used_1 j_ l g- Min/l "Drop: S. D.. Usable Area Provided © -SE. See No. of Bedrooms j , Septic Tank Capacity k000 Gals. Type N\-Alabo Absorption Area Provided ByL..F.x2�+" ✓� 3�� width trench. er Address r��c. 'pia SEAL THIS SPACE FOR USE BY HEAUPH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date Ilk U 4v 18 MO 4 O r-, .i o W � J �!6'tsrQ �} , t,<i c .� �•. 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