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HomeMy WebLinkAbout2146DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -28 BOX 19 02146 !7- . ;r , ,� ' 1 ' T;,' 1 ')--r INS j L - 02146 PUTNAM COUNTY-DEPARTMENT° OF HEALTH , l+ :' _'' Division of; Enviro�menta/ Heald► Serv�c�ea,�Carm% N xY 10512 paihnit " V / CERTIFICATE OF.CONST.RUCTION . tCOMPLIANCE FOR - SEWAGE DISPOSAL'SYSTEM 1 let ,'',Cds.' t: r _ a .n..a a 0 • s ,•, .z Located. at. 1 W�? r. � , ,, , ,. *• • .� Tax Map ck - ;Owner % -`�� ' rD'• o erly > f L :SeparateSewerage System built'by �� Address i` s/C0 /79 C�'9y� r Consisting Gal. Oal.-Septic,Tank.and !r'. 9G'r ����� ��Y �� • " Other requirements }' a Y ^r ti,' � ,� ' ..� ✓'�� e•, xt ` `' '- s� ��KT;� � $ a _,?i�Y1rt ta., (� ��,Ht� _ij . � •: � x Water Supply t- Publlc •Supply Flom �.. ` , `" " �'" " y y ;w 'Pr Supply - Dril Address•' /�/' BuNding:Type of Betlroomt Date Permit Issued * 1 ;Has Erosion Control Been Completetl7 i certify that;the systems) as;.listed. serving the above °premises'wera constructed essentially a( °shown on t'he plane of the completed work ( copies ;of which' are attached) ':and iri,pccordance with the stagdarda rules and ;equlations >in accordancg�wi�;h.: *t'}ha yfiled�p an, rand the permit issued tiy. the ; C '•,Putnam Count De rtment`Of Health " ' `�t '`P��, =+ w'�fa e� y pa x � ° Date Ce t�fied by ~- " P.E R A }y Address �s/ ti f2 4� it ? e Icense No s b 'Any.;person occupying'premises'served by',fhe oJe systems) shall'promptlytake wehaetionasma� necessary,to seoyrsthe,eoriaetlon• of ;any unsanit6ry' conditions resulting, fiom • such''usage approval •of the separate- sewerayo - _system hall becomeriulJ� and w_oldgas >o�► afsspublir sanitary- . ewer becomes . { -avgilabicand the approval: of -the private`wetec supply "shah become' ,void' when a' public;rter pplyo b�eomesFy?ova ilabte: Such .approvals are 1 ;''r .wb)ecL�to mod{flcatton or ehanye when, ari the )utlgmenY.- ,of,the•C mmis,- ner of Health, -iuch r n,;motlifteafton or- ehange;is, hecessery , F .'j�'p 4....•- •y.•.� / . ��i�j•V��� .hr < Date By —e. ;Title i fit. T, -;Rev 9 -81 -• :.r. -. - r .. - � 1 m AL SERVICES, INC p 'NQ. ML R (� �q$ ?5 fENED ❑ OTHER ❑ ENT ❑ OTN ER - : - AM TfM E-----' : - WELL 3/71 au 4 )MPLETION REPORT PUTNAIM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK report is to be completed by well driller :a sutimitfed to County Health Department together with laboratory report of ysis of water sample indicating water is of "satisfactory bacterial quality before certificate of construction compliance is issued. ",..REpC3'1iT 'MUST_'H(E SUBMITTED "WIT'FiM► 3,6" DAYS ' "GF- WEL'L "COMPLE'TIO > NAME .. ADDRESS Ow .: .... . , .. '(No. 6 Sfreet) (Town) ' (Lot "� Number) " ^, OF ❑ ❑.FARM ❑ TEST WELL PRO DOMESTIC ESTABLISHMENT USE W PUBLIC El ❑ _. AIR ❑CONDITIONING OTHER (Specify) SUPPLY INDUSTRIAL DRI COMPRESSED ❑ CABLE El JDTHER ❑ f(Spscify) Ed" T. ROTARY AIR PERCUSSION .PERCUSSION CAS CE GTH (feet)/ OIAMETE (1ncAes) WEIGHT PER FOOT( 9:THREADED 1:1 0 ? € —V []NO DET h WELDED YES ES NO' _ YI ❑ HOURS ❑ G.P:M. YIELD'(a.P.M.) T BAILED PUMPED COMPRESSED AIR °W� MEASURE FROM LAND SURFACE - STATIC (Speclty teat) DURING YIELD TEST (leaf) . Depth of Completed. Well in feet below Land surface: — MAKE H OPEN TO AQUIFER (feet) LENGTH SIC DET; SLOT SIZE -(Inches IF GRAYEI Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) {° PACKED: gravel pack (Inches): DEPTH ;F LAND -SUR /ACE Sketch exact location of well with dlstancea, to at /asst FORMATION DESCRIPTION two permanent landmarks. F.E.• o FEET yield was #a fed at different depths during drilling, list below FEET GALLONS PER MINUTE '1 DATE W COMPLE ED DATE OF REPORT WELL DRII R (Si9riat1,,,6 / ONE LEE Owner or urchaser of Building "u •, "BuY.� ding "'' C "oris t�rur: /} j Location Street Municipality Building Type Section Bl 6'&k Lot Subdivision Name Subdv. 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- ation of the-Di-rector-of the-.Division of Environmental Heal.th.._Servi.ce.s ., of the "Putnam- C`ou.rity "Department " of `Heal "t'1i " -to ­wYiether "' or '- not '--t1he ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. 4/ • ` Dated this day of ,� 19 Signature Title— 0.X4 ^'.p L Corporation Name if corp.) 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 \1��� m s PUTNAM COUNTY; DEPARTMEN j- (L Division of <Enwronmenia/ Hea /tti Services ,CONSTRUCTfON PERMIT FOR SEWAGEy'DISPOSAL SYSTEM I L at `. /J .Located � '��• -� SLCd vision - �^ �� Subd Lot q� 1 D -owner /Address Y i a� ✓1'Gt:,..r1C'iII Ytc t t�, j7 / �I 71 y' i. r �8u11d�ng:TyPe �.� 3'i:wt c'' Lpt 'Area': , L ty Number of Bedrooms � �Design'">aow G /P /D Oe1 k Separate .Sewerage System to cor"sist of 7�G } Gal Septic Tank, ' ,To ,De` constructed by s ��� '' n Water Supply JPUb1ic Supply F►om �' Pnvate Supply to be dnlletl by `� -` ��ti5 -•cF 4'', 5 n 7 kn. }° . n a„n t Address'•. z� Other Rbqu vements (,represent that F am wholly and completelyiresponsible for he tlesign' and location of the• L &bove described °w,ill be n", tructed as shown on the approved amendment there to and.fima County ,`Department of `ealth;, _and that on complehort thereot a Cert�fii atp of Goristri wbniitted to `the DepartmenC, and a -- written guarantee. will be ,furnished' the owner; place in "good. operating -iii nilitipri any part of said sewage disposal system during the ante of -she approval of, the Ceitificate''of Consti:uction,.Compliaficenof the ongmal; iys will be. located =arshawn on the a'pp'roved plan and th5t said ,well wilt be, installed m acco`rtla �i s County Department ofxHealth z i s s r 8y HEALTH Permit f� N Y 10512 mown or ' IagV� a -� Z .�. lock: Rcvarign ,` Approval ion Only ❑ - Notification Required w 1 Y • v�4"��.,' „�, #. �r � s, xr ^- of �• .i a x f systems) 1) that_ the separate- sewage disposal system with -444 ds, rules an , regu ations,of the u nam mpliance satisfactory, to' tlieCommiisfoner,ofHealthwfll•' sa`lie"tii3t'O_Aassigrir:by the builder; that, said builder will immediately follow irg,fhe'data of the isw- [f 9i3� to °; 2) atiat• the drilled well. described, above. �f #sndard .Igles° and, regu a— a 5;ns of • the Putnam. A u.: .� P1. RA "`* ° ^ License No o^� constructionyof� thepbuilding has 16` eeh 'undertaken and is ierkof Health, Anchsnge or. alteration of - construction it Au P I W, zor(lyy°`a'W V M.,3 t �o � Sills - •M� � E v, h '. 4 i y 1l s r 8y HEALTH Permit f� N Y 10512 mown or ' IagV� a -� Z .�. lock: Rcvarign ,` Approval ion Only ❑ - Notification Required w 1 Y • v�4"��.,' „�, #. �r � s, xr ^- of �• .i a x f systems) 1) that_ the separate- sewage disposal system with -444 ds, rules an , regu ations,of the u nam mpliance satisfactory, to' tlieCommiisfoner,ofHealthwfll•' sa`lie"tii3t'O_Aassigrir:by the builder; that, said builder will immediately follow irg,fhe'data of the isw- [f 9i3� to °; 2) atiat• the drilled well. described, above. �f #sndard .Igles° and, regu a— a 5;ns of • the Putnam. A u.: .� P1. RA "`* ° ^ License No o^� constructionyof� thepbuilding has 16` eeh 'undertaken and is ierkof Health, Anchsnge or. alteration of - construction it Au P I W, zor(lyy°`a'W V M.,3 t �o � Sills CON�UUCT,16N OE FOR L_ SYSTEW7 Bidck ob iG Owner res C7 Building tq__ u bit JotAl 11, -Square Feet ara e rage o 6er Requirements' | j || 0 NST 0 64, ,rIV@pfV%2pulations,'of the,., pi N, cl�b6ilcleir will at,.t &i ll.clescribed- above i :0100 undertaken and is /17 t7 / v>/i ��•rT /goo' z A F V cp L DIC la JA 30 e ""a AL TO SEPTIC TANK.AND FIELDS ...AREA ','�RESERVED 'I'O. SYSTEM TO FiEfAMN UNDISTURBED ALL CONSTRUCTION TO CONFORM Td'/&A AND LOCAL STANDARDS' AND REGULATIONS'.. 10 60, A Ict- 3 c'. SOIL PERCOLATIO RATE ....... ;IN/IN 900 GALLON SEPTIC TANK DEEP TEST .. 210 6. k/ I . 1 • 300 L P Y _2_1 ABS. TRENCH P2 /9 A/ 7r 00 & 1�1 004 �r27 0 & tit 0& A14. pie'? 2 2r4- 7_,¢X ^/ Q Ap 810 CK ,e 4o, 7 'Z PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM V, � 4-o o- � p a, c c c, l< TOWN OF i5xi V-% a -COUNTY, NEW. YORK DATE , 2 SCALE . A- - SULLIVAN CONSULTING ENGINEtRS .w 1 A --'2S . s j ` F d• J i rJ 9 .i J f ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ... ✓, . AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURSED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS ✓. 1 , , _.. Q Q ell J A P PR (�� l 1 APR7 97� DIVISION OF 'i y ,.nnwuxMni HFNTH &FRVIC� j j P P y. , YY ^ ^ L SOIL PERCOLATION RATE ...'V .... .... MIN /IN I ltjO GALLON SEPTIC TANK DEEP TEST,V . /ey�(J �, 3•i,�. ;i Alo Zt't.t .a f„ rJ fJ LF X 24 ABS. TRENCH ..1 81 o cit r .0 ca 7 Z, I PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM �/tc-Ear S Pa4c. a rt° �1; TOWN OF Pr3 4 c COUNTY. NEW. YORK DATE 31 y 73- SCALE A..S •SAwrs I JOB NO. ]Q ► /_S -- SULLIVAN - CONSULTING ENGINEERS ll�' t` PUTNAM COUNTY DEPARTMENT OF HEALTH Division of: Environmental Health Services, Came% N Y 10512 CONSTRUCTION ,PERMIT _FOR. SEWAGE :DISPOSAL SYSTEM. .0 rr?; • �JA� or ViIIa ge �� l„a : Town - `� '` Section < ,Block y, , Subdivision ;. :•. =" °': -' _ .: � . • .. `� Lot - . .� x• Owner 4A G A rr AddressD D�J /"r•Gb A vi Building Type Lot Area s Nu ber ;of Bedrooms ;;fi Total Habitable ,Space :3'00 `a•! — Square Feet Sep arafe';Sewerage- :System to consist of �! DQ' Gal Septic Tank %SO,.. lineii feetrx d4 width ,french :To be " con structed by ~ ss � v ' Addre upP1Y :Public Supply From } { Water S " Private to .Supply be drilletl by ^ Adtlreis q� t t . •;Other„Re uvements - 'I represent that I:am wholly and ,completely•responsible for the design and location of;the proposed system(s);' 1) : that the separate sewage disposal system above - described will be constructed a "s.shown.on.:the approved amendment there to and` n accordance wjth the sfandardS,.rules an regulations o . e.., Putnam County,,., of `.Health, and that'ori completion thereof a :Certify cafe of Construction Compliance � ty r'y to the'.Commissioner of Health wilF be submitted to:'fhe Department Wand ;a written guarantee wdl be furn,islieil the owner his successors, t seF:a4WAP the builder; that said builder will :.place in `good operating condition any .part•, of said sewage disposal system during _the period °of t,�ye$rsdp�ned° ''following 4hedate of the 'issu 'L_�; ance of .the approval of .the Certificate = of= Construction 'Compl,ance�of tfie original systerri_'or an" ?eV i ,� �p3 drilletl well described above will be located as shown on the ap`pr'oved plan'and''that sa�tl well will be installed in accordance itfi� he :, ifatds,,; ui� r d `r ulaions ;:of the 'Putnani I Countyl epart eht of Health Date �• - {' Signed £ e L e�;3t a P E R.A. .APPROVED FOR CONSTRUCTION .This:app`roval exp!res.one year from the date rlssued unless t.➢1#if cti y ti� &-has -been ..undertaken and is revocable "for cause or may be amended or'modifieq when con u r b sio, 69 nr al lion of ,con6 n requires a, new, ermit /II (/� %� /proWS posal "of dome Hilary sews a and pr e.� Date -� �, BY �4T ills ,... .. PUTNAM COUNTY DEPARTMENT OF HEALTH COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Located at (Street, d�(ii4WAI Sec. .S Block % Lot' �. > indicate neares cross street) Municipality f a ry, a; p-�7 yo/ e SOIL PERCOLATION TEST DATA RE� Watershed TO BE SUBMITTED WITH APPLICATIONS 3 5 3 4 5 1 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 � 6 L Sr /;S� 41011 3 5 3 4 5 1 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION . _...... ,. ._... DES- Cl�IPT�?ON..OTa:S. OILS,:: ENC_ OUI�ITERED;., �. Y�i .E�T:..HQ��- --- _•.:.�::.,R.:- �'��,,�.�_��' -� ... DEPTH HOLE NO. > HOLE NO. 2 HOLE NO l G.L. 611 12" _ 1811 �� �a ✓c° o� ✓�� �l'i 2411 3011 . 3611 4211 48'1 5411 6011 66'1 7211 7811 84'1 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHIC .WATER LEV� ISES AFTER BEING ENCOUNTERED TESTS MADE BY j /'/ y Date DESIGN Soil Rate Used 4( Min/1 �� Drop: S. D. Usable Area Provided ;!1-V00 ,- No. of Bedrooms 3 Septic Tank Capacity &e—) Gals. Type Absorption Area Provided By�L. F. x24" � �w� 7-'H' -$,renc . ,o9�'h�r�•'�r$ s Pout CEP ' .� n. Address 0- La w—k ftc �- q, THIS SPACE FOR USE BY HEALTH DEPARTP/IENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by �a � GL Date T-- \1 to -5,n r� i // (o /- qts- f fit- C.A. dam•_ -- h� f - o/ k� ej .' p4- elI N 8 `; 4 1 Q , ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE 9F LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO SONFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS.......... a I J -� Qce",4, . ,-, % "--4 ez �x,3 /jn5 P APPROVED PLAN Qd SOIL PERCOLATION RATE ........4........ MIN /IN DEEP TEST .. /✓O � r-o ij n d We; /✓o L C. Ll c 1) 11,174 }UT gR1 Of H EALTh SION OF WRONMENTAL HSALTN SEKYL® J X100 GALLON 1 SEPTIC TANK O LF X +FLABS. TRENCH n� ' �0 SSps 100 P�apo1 S�.d y a�t ' Ti 7 ! N 1� Wr r � u \~ - E s: TAX MJ� P S QLVC!( /s L o Tl. / PROPOSED SEPARATE SEWAGE DISPOSAL f SYSTEM v C + y- SPgGG At c'l i a- pic ktown TOWN OF p q m 4 c. `. COU TY. NEW YORK DATE 11 C7 7 Lf SCALERS 11 W n J08. NO. ) 14 - 7 LA SULLIVAN - THIEDE! ;; CONSULTING ENGINEERS CLARK PLACE MAiMPAC. NEW YORK • 1 x' • it 41 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION-, OF , ENVIRONMENTAL ''' -HLAL-TH'-S£RVICES - <.._ �_..... Date Re: Property of Located at ,Zi° Gl"'"6 WW / 41 Section Block / Lot a. / 'Gentlemen: This letter is to authorize a duly licensed professional engineer `� or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and. to sign all necessary papers on my behalf in L: V111jtVV LiV11 w.L i.Il U"b u1d C Lev anti to. supeI' vise ini e construc ciun of said system or systems in conformity with the provisions of Article 145 or - .. - 1.4a;--- Education- -raw; -.the Public_- Health -Law,. and the..- Putnam _County San-i- 'tary Code Very truly, yours rie ... Signed 7&IA Owner of Property �• d P r� C Uun e Ai5'iT� �i e n . 6 ifi � � Q �� Address P.E.,A., 6 •_3 SZ -8.72 '71 Telephone Address Zjege,7 Telephone 1 PL . p Gj n rr 90 Oct -C) 00 4. . P ;77- O LA 7c 1 PL . p Gj n rr 90 Oct -C) 00 4. . P