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HomeMy WebLinkAbout2234DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -42 BOX 19 02234 .' .. x; .� Ir �, I ,6 02234 NT -S WAGE DISPICiSALIN mn ` be,conStrildtad by.- 9 pp private- Suppi be drill - ed 'by ev,g,�Ot her Requirements i',: '.',will beAocated as shown on thi'approvid Wan,and that.rSaid Well Will beAn S Al tl -ENGIN,EER-TO:PROVIDE PERMIT rii A-1 7. Town or v mage� _Block Lot ova .;,t that -the. , sePara'te sewa' 8-disposal system i,n-,iccordin'co',v�ith�the.�t'iiidirds.,r6i,is and regulations of the putnam lance! ,satisfactory' to b9"the builder, that said-builder will.. ssued 'unless 5onstructiori.of the building has been undertaken and s ommi ioner `61 'A � F PUTNAM COUNTY DEPARMM OF HEALTH - DIVISION OF ENMON ENTAL HEALTH SERVICES INDIVIDUAL VWM SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS _..... FIB ?SPA _ N.:.REPO T.- DATE: 7- 2 INSP. BY: of er) (Street tion) ITIAL SITM INSPECTION (D 3 1 P YES I NO CQ etlands 90/or p" imate to property......... a... Property./lines or corners found ................... Can i.mate house location ....................... Willdriveway need cut ............................ Must trees be reeved - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed..... . ... . — Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics. .... o — ................... D. H. 1 Lot Depth to G.W. ° Depth to rock 0 ft, 3 ft. 6 ft< 9 ft, 12-D D. H. 2 Lot Depth to G.W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. I DATE: FINAL SITE INSPECTION INSP.BY: YES NO CONUS House SSDS located per approved plan ............. Length of trench measured Width of trench average ° Slope of tile line and trench acceptable......... Roan allowed for expansion trenches > >............ Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............ ... .......... 10 ft.. maintained from property line and 20 ft. from house'... ...... < ................> Distance well to SSDS (ft.) .... ..............e... Number of bedroans checks...... — ............... Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench. — o ........... 15 ft. of peripheral soil horizontally fran trench ................... ................. Boxes properly set ..................<............ Could surface runoff frcn driveway, roads, ground surface, etc., channel near SDS area.— ( � Does lot drainage appear OK in area of SDS..,.... FINAL GRADNG OF SITE ACCEPTABLE .................. 1. -f PUTNAM COUNTY DEPARTMENT OF HEALTH ,_ r _DIVTSif7N` OF' -EIV RON ' l THL L� amv COUNTY OFFICE BUILDING, CARMEL, N. 1. 10512 DESIGN DATA SI'''T- SEPARATE JEWAGE DISPOSAL SYSTEM FILE NO OW1 If i I'^ AcI.I.TP'tjtin J �'� 0i Located at ('Street h Sec. (V Block Lot n ca a nearer cross street) Municipality 4 I Watershed .5 0TT, Pl ?Rrc1TATT4N TEST DATA Ti.FRtJTftFD TO FE ST]SMTTTED. WTTH APPLICATTCNS lol o. NIiuuYuor CLOCK TIME, PERCOLATION -PERCOLATION - -`Turn 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 Tnnhan Tnches. Inches Notes: 1) 'Pests to be repeated at same depth until a roximately.equal soil rrt�,r;;3 am obtainod at eacri Percolation test' hole. Alf pp data to be sut►wi.tted for review. 2) Depth.measurements to be made from top of hole. �A Cp�� PUTNAM COUNTY HEALTH DEPARTMENT °W °Iv liiVSiuiv` -OF "EeTVTkc71MLNiAL "HEALtH SERVICES John M. Simmons,. M D Deputy Commissioner of- Health - – FIELD ACTIVITY. REPORT'- Sheet of INSPECTION NAME 1r ?l tpa`(" Orig. Routine. �AK6f'i —_ Ori Complain ` g. ADDRESS IV° t�6flca��R�li• Orig. Request No. Street Municipality (T)(V)(C) Compliance _ 7� { / - MAILING.ADDRESS T...V ,., /� �""s� - .: Complaint Comp. nt C m Finalal P.O. .Box ; -Post Office _`Zip Code Group Illness Construction TELEPHONE, Reinspection PERSON, IN CHARGE Field, Sampling Only OR " INTERVIEWED C !� �rfe Field Conference Name and Title DATE. "" 1 TYPE .FACILITY S . Other TIME ARRIVED-,-, /D -0 - TIME LEFT Explain -FINDINGS: c -. - 6b' �4 INSPECTOR: ....' = TELEPHONE: ig.natu.re nd,' ' tle PERSON IN CHARGE OR INTERVIEWED.=, . I- acknowledge receipt, of a copy-'of, this'.- SIGNATURE: Field Activi't'y Report.,. , .... ,' , .... TITLE : _ 01RA TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST:HOLES HOLE NO _ H • `I RAM I • 24" 30" 36" 42" 48" 5411 60" 66" 72" 78" 84 if OLE N0. emu, _ l^GpSC31y� � � G DSG 1 Vol �-- ►' --�'�- ►J vHP a� J PCLQ �l �r i-� INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED � INDICATE.- EVEL--TO WHICH= WATER. LEVEL RISES AFTER, BEING_.,EUCOUNTERED:_ _ - TESTS - MADE -BY- _.. -��___ . .�t-f�r9f eF- Date DESIGN Soil Rate Used 1VMin/1 "Drop: S.D. Usable Area Provided �% No. of Bedrooms i Septic Tank Capacity Id�' Gals. G Absorption. Area Pr— ov d By_Zn L.F. x24 " - 1 l her Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil ,Rate Approved Sq. Ft /Cal. Checked by Date .�. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of NA Y i",O? L'I; Subdivision . Date kd WA Section 10 Block I Lot . Subdv. Lot 4015�' Filed Map ©� Date g • 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 wj.th the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necess.ary.papers on my behalf-in connection with this matter and to supervise the construction of said system or systems in conformify' witfi the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. F_ Countersigned P.E. R.A., # 0- OF NEW I Address .21 &J toki 2_ A Very truly yours, Signed Owner of Property zj Pki Address Town Telephone Tp� CF=-��. 019 ll--�"n-'l-----,---'Z', !AkjT- of PNE L - JCr -N4 ALL AT A A 2=aT L VAC A KJT No Oe- is-&PTIC-s CC-AF-1