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HomeMy WebLinkAbout2197DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 30.18 -1 -66 BOX 19 02197 i� him, 147 ■ �ir ; T IIII IN , . r so IN IN mr 02197 PUTNAM COUNTY DEPARTMENT Vk tj ALi n a, �3 Division of Environmental Health Services, Carmel, N. Y. 10512 "CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town Located at l/VG.�� � �'ii>st r eeUen Lr%� Block d�a �t f� .. , •����-/�%li�nr,� l�.A� �� Lot � � Job r� 2dle ie� Z TM Address /,- Owner �% — Building Type , Lot Area 94� 44 Total Habitable Space d&�4P .7'16' Square Feet Number of Bedrooms I e. Separate Sewerage System to consist of ��Ci Gal. Septic Tank rC� lineal feet X width trench To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Address _ I Other Requirements SAP cls w`� L I represent that I am wholly and completely responsible r th �esRn and lo F Ep the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the ap f4nen�.e�.., accordance with the standards, rules an regula ions o the u nam County Department of Health, and that on complet' t reo : 'Cq,Ctti Co truction Compliance" satisfactory!to the Commissioner of Healthwill be submitted to the Department, and a written gu nt a wi ►. fut� t e r, his successors, heirs or assigns by the builder, that said builder will place in good 'operating condition any part of said w ge d �s'at�6X dur a period of two (2) years immediately following the date of the issu- ante of the approval of the Certificate of Constru Cr Com f "i ce ofii.i3 on inal stem or any repairs there ; 2)'that the drilled well described above will be located as shown on the approved plan and that i� ell ' Jb in dance with t stan rules nd regulations of the Putnam County Department of Health. J'F �'o s O � Date � !T— �'� 2 3 P. E.. R.A. License No. Address ,PPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is vocable for .cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction tuires a new permit. Approved for disposal of domestic ary ewage, and or priv wa supply only. By Tittle e PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental 1Health Services, Cannel, N. Y.-"10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at Owner dr/C/y�iP/� Separate Sewerage System built by r/ 2 `����� ©� Consisting of L— e–veal. Septic Tank /� Other requirements Water Supply: Public Supply From Private Supply Drilled By Section 00_9 Lot If -� Address 3ae9lr'C"7?Ge lineal Feet X -346 Address s " Building Type a .rte j u+ No, of Bedrooms Date Has Erosion Control Been Completed? 1 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the attached), and in accordance with the standards, rules and regulations, plans filed the permit ''sued' t/ �s? Date 24 Z 7 Certified by A Address Any person occupying premises served by the above systems) shall promptly take such action as may be n conditions resulting from such usage. Approval of the separate sewerage system shall become null and available and the approval of the private water supply shall become null and void when a public water subject to modification or change when, in the judgment of the commissioner of.Health, su h revogd By Town or Village Block 0 Job r width trench V1 r iit I ssued n,1. avork ies of which are ihir ` 601ntyd e'p ant of Health. t .' - R.A. ., go - License }No rethe;t rrdction!1oft ny unsanitary a p lic sanitai� � wer becomes s a. vaep"Ib. e' ugh approvals are �rt�r.= cffSQg�� is+ necessary. Title y WN W L BAGTERIAPER ML. (Age plate count at 35° C). „OAIJI/11 R- OUP - (:0- r+aa r .aa++.r++ . COLIFORM GROUP (MosU probable No. /100m1.) -, - � - •- -- -- - :. HARDNESS; TOTAL - ppm DETERGENTS - PPn? NITRATES (as N) -:PPM I R TA ON, TOTAL.- PPni m a A - r APPRgVED� Ir 30' OCT 91974 ul ........... /000 GALLON SEPTIC TANK DI R, DIVISION OF ENVIRONMENTAL 13-7 LF X-5 �' ABS. TRENCH NEALTH SERVI 0 GZ_ /-9 A/ /" r 00' 61S: LS 7.. Q A AS CONSTRUCTED,. SEPARATE SEWAGE DISPOSAL' SYST TOWN OF 7,777777 el rIV,91'1- COONTY. NEW iYORK -' DATE 6- 6- 74 SCALEA-5 'I-4CJW1✓ 40B j NO - , , ;:� SULLIVAN - THIE CONSULTING ENGIN ,,gRS CLARK PLACE 'N' -Y, IM ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGf. OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN -UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS .: .......i 1 1 �1 ! . . \ 1 1 1 ' j 1 i 07 ,v ° 4 °U 1 � \ 1 � 1 � t 1 SEPARATE SEWAGE DISPOSAL SYSTEM 1 ' `nV TOWN-OF v il' v UATE_-�? ^ /I" ' 7_4,1 SCALE >73 - 'JOB NO. 79.'- rY8 SULLIVAN THIEDF. S �S DIRMOR, DIVISION OF 0WIROSIMlNTAL HEALTH SERI r 1 ' j 1 i 07 ,v ° 4 °U �f�X irlF7 i �r f1 P P 4 B� e ter/° 2 L PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM Ui V `nV TOWN-OF v il' v UATE_-�? ^ /I" ' 7_4,1 SCALE >73 - 'JOB NO. 79.'- rY8 SULLIVAN THIEDF. CONSULTING ENGINEiE:RS t' 0 'a AJ 4� r 1 ' j 07 ,v ° 4 °U �f�X irlF7 i �r f1 P P 4 B� e ter/° 2 L PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM } x` ) TOWN-OF ..- .vl CO NTY, NEW YORK . � UATE_-�? ^ /I" ' 7_4,1 SCALE >73 - 'JOB NO. 79.'- rY8 SULLIVAN THIEDF. CONSULTING ENGINEiE:RS WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 Division of Environmental Health Services COUNTY OFFICE BUILDING • CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED.WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME R %C. L \G."C� abRke z:o ADDRESS 13u -aN t _Sa.z7 Li n ►/ `�. eY. LOCATION (No. a Street) (Town) (Lot Number) - OF WELL M d VVg,4 k4 Putnam Valley N.Y. nn BUS I NES F1 ❑ ❑ PROPOSED LAJ DOMESTIC ESTABL SHMENT FARM TEST WELL USE OF WELL 11 ❑ ❑ ❑ Supply INDUSTRIAL CONDITIONING (Sp"if ) DRILLING COMPRESSED CABLE ❑ ❑ OVER) ❑ EQUIPMENT ROTARY W AIR PERCUSSION PERCUSSION CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT j� 11 0 ❑NO CASING DETAILS 22 6 19 ,iJ THREADED WEIDt:D YES YES NO YIELD HOURS ❑ ❑ © 2 G.P.M. 7 YIELD (G.P.M.) 7 TEST BAILED PUMPED COMPRESSED AIR 1 WATER MEASURE FROM LAND SURFACE— STATIC(Sp- ilytestJ DUPING YIELD TEST (Net) Depth of Completed Wall LEVEL 30 total drflWdOWn in feet below Lord .urfoca: c305 MAKE lENG7X OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches IF GRAVEL Diameter of wall including GRAVEL SIZE (inches) FROM (1111) TO (Ise t) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at /seat two permanent landmarks. FEET to FEET 0 8 clay boulders kY � Y . 8 305 granite l t t i Rf Y 1 4 i "A 4 If yield was toted of differ.., depth. during drilling, li.t below FEET GALLONS PER MINUTE a 240 „a g f s t tr +t 1 y r •\ i t X alL < C 4 1 X a{ t,� 4F U t�S " =N +�' +v f 5 L �' ry'1 D TE EL COMPLETED D OF REPORT WEL D ILLER ignatu n m r � � �., ,t,• � a .lea ai .. 7 Wee Ow�ner or Purc aser o Building 7 Buildfng Constructed by Location - Street (!J 1 s d epy )-7- Building Type i. I Municipality I 49 0 Section 11. .. 7 Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, wor�nmanship, 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 succes- sors, 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 :Wade 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 de- termination of the Director of the Division of Environmental Health Ser- ..vices of the Putnam County- Department of Health as to whether or not the failure of the system ,to operate Taas caused by the willful 'or negligent act of the occupant of the building utilizing the system Dated this h day of 19 7,y Signature_ Title lr 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 .e... r �. .. .. .. .. .. ... .e .:...� -..`. _. �... . -rv. a .. ...- .. >� :. .. �.. :...�–. F :..- ,. Yt• :]�. —:t .. t... .�. V -i. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of /Qleww o a�z z Q Located at_! cwt y\ a h, C3 i 1 Section block Z Lot Gentlemen: This letter is to authorizeZ'�--is c_ /_y la/, 7d4z --' a duly licensed professional engineer r✓ or registered architect (Indicate) to a PP 1 Y for a Construction Permit for se parate sewera g e system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Tl....... y .1- XL TT.. - 1 1 L 1 ! '1 .t Depaitmeint vL ncaiUu, and to slgn all nece66ary 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 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi -• P.E., ., # -;;r560Z — Very truly ,ours, Signed Owner of P operty `f res /®Z 320 f — Teie one I i s 4Z.. ♦ . PUTNAM COUNTY DEPARTMENT OF HEALTH DiVISTON `G ENVIRONME 4TAI;''HEALTH -SERVICES- COUNTY OFFICE BUILDING CARMEL, N. Y. 10512 t DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NG GFwner 1 &Cjo— iv°Tl �/@�igK..1�N.v�/'�R✓�ddress 58 9 .8roo.�Lvv .� . 11273 Located at (Street Sec . Block G z- Lot 49311 n lca e nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS i Hole- Number CLOCK TIME -. PERCOLATION I PERCOLATION apse Depth o. a er Water Levei No. Time -- From Ground Surface in Inches , Soil Rate Start -Stop Min. Start Stop Drop in iMin./in drop Inches Inches Inches to 2 /o; S� / /,'os' Zo 3 170 5 �. 2 ; *lD; SCl / /,' /46 - - Z� A ¢Z z¢ 2v 2 3 8 2 P' 4 5 Notes: 1) Te'gts to be repeated at same depth until approximat'e1yy equal soil rates are obtained at each percolation test hole. All data do e submitted for review. 2) Depth measurements to be made from top of hole. 1 i si AU� Ta i pac n11 Aj.3 g � 4s HEALTH E-'- FOR USE BY n," tkvig - NIRk 'prove XT 9� AI, ffff PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY ICE BUILDING CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM, FILE NC OwnerA� Address /S,5/- 9,gy -41PZ6-1 9'e� WEST /c'0.90 Located at (Street )4 ,i,_,5S 009, Block 0Z I �inc[icate neares cross street) Municipality v7-,09 417 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH A CATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water No. Time From Ground Surface Start-Stop Min. Start Stop Inches Inches Water Levei in Inches Drop in Inches I I '- Soil Rate Min./in drop 2 /0 Z -3 3 4 5 1 2"le 0,'/7 5' :3 Z. 117 3, 4� 2 3 4 5 Notes: 1) Td'sts to be repeated at same depth until a roximatel� rates are obtained at each percolation test hole. Aff"data to for review. 2) Depth measurements to be made from top of hole. equal soil e submitted TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE -NO. HOLE NO. HOLE NO.— G. 6" 1211 1811 2411 30" 3611 4211 4811 5411 60 66 7211 7811. 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ,INDICATE LEVEL TO WHICH WATER,LEVEL RISES AFTER BEING,ENCOUNTERED.--- TESTS MADE BY Date 5? ..—DESI. Soil Rate Used Nftn/l"Drop: S. D.. Usable Area Provided— -500 0 No, of Bedrooms 3 . Septic Tank Capacity, O OF Absorption Area _Provided By L. F. x24 5b ci&7 -A mtAnch. 015�VpV I-V7a"j- .Name bignature 11 161 AM. S Address CT & THIS SPACE FOR USE BY HEALTH DEPARTIENT ONLY: Soil Rate Approved —Sq. Ft/Gal. Checked by Date