Loading...
HomeMy WebLinkAbout2288DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.09 -1 -5 BOX 20 ., rm ' .i�' `l., ,, , + IgL i PUTNAM COUNTY DEPARTMENT OF,HEALTH Rev 3/6: , Division of Environmental Health Services, Carmel, N` Y; 10512 Z J� n (� Engineer Mnat Provide 2$ =g P C H D Permit M s t;ERTIFICATE OF CO TRUGTION COMPLIANCE:FOR SEWAGE DIS POSAL SYSTEM, i,�r Loeatcd at - - '`vale' 4 P +� Townorill>Zge Owner'/ H ,.� '2 Tat Map —Block ELL Lot app cant Name I C) F ormeriy Subdivision Name__ MfiWng Address ZI I p ;- ate Permit Issued iY Sub& Lot Separate Sewerage System ].,, by Address V't'IG.> Tsp, Consisting of (`� ii 3 ©p 1 1j Gallon Septic Tank and Water Sapply Pd Supply From Address or Private Sapply'DrIDed by 5. q Address ayr�•c a pj�. Bull Type on Control Been CompletedY Number of Bedrooms Has .Garbage Grinder Been InstalledY =� Other Rega)rements - .'I:certifythat the'syeiem(s) 46,-j isted serving the�above,,.premisas. were conetzuc ed.esaent all aseh, - of which are attached), and in accordance with the standards ruleE and regula one';' cco Y tutnem County Depar nt Of Health" .: ease y wn the plans "sof the completed: work (`copies , on } filed plan, and the permit issued by the. !j Oats �n21`�i s? Certified :by ;- - .Address'. Z ._ .� PE � RA: L cent Any person occu - in D Y A ;No PY g Dremises served by the aDOVe system(s)'shal+l prom tl take wch actbn af,may,be neeetsary,to,peu ► e.,tMr or ' conAition; ►ssuiting, from such usage. Approval of the separate rewera c ►action ot:enY :untsnita►y P" available and the ;a ge system `shallbecome null anq void as soon at a_ :Pub .' sanitary: sawir °tiscomet pproval of the private water supply shall become null and vokt when - a puDlir water wpply<Ocomii'' su6)set to %modification or change w: :hen in -;the u _ wailabN,_: Such _,approvals are n �' 77j dgment Commissi f Health di revoeatlon moatfieatlon "or change It r»cistapr ENGINEER.TO PROVIDE.P:ERMIT # i �, PUTNAM COUNTY DEPARTMENT OF HEALTH oN: ceRT FicaTE :oF COMPLIANCY �` Dwision of <Enwronmental Health Services, Carmel N Y 1007:,.' PERMIT, Q4.w� �4� ISTRUCTIUN PERMIT EQR Si�WAGE 6ISPID$At SYSTEM Town or liege , �a I�OC� 1 1 lA)Ld7L� 1. "Tax -map $look �t 9 tad at Y`[�K o\ KOai� D��R7 tom` Subd Lot N T Renewal ❑ Revision ❑ ivision A P - ��ZD��r.Q y 2l"i f!Q e�/iew ('3de W�'` • ate Of PrevioUS ApprObsl I /Address (2d'�pQVLQr` Lot Area ti cv Fill Section only ❑ un9 'TYPe pp Design Flow G /P /D F.C. N. D Notification. Required. ber'of Bedrooms �— _ rate Sewerage System to consist .of I�ryUO- Gal. Septic Tank and 3n� i1, 2°j lWd2 t�b5 f ie ;constructed by �.fO `2Cihidti: Address i r Supply. ublic :uPoly From I Private Supply to be drilletl by 1.9�s trw. Address sr Requirements resent that 1 am wholly antl, completely responsible for the design and location of ths" pordance with the standards; ules an aregu a ons o 'SPoe I U nam re described will be constructed,as shown on ttie_a`pproved amendment the[e'to and "m cc. e artment of •Health,, .arid -that on completion thereof a- ''Cert�fwafe. of Construction Compfs heirs or ass gns by the buliddr.- thatnsaidibu dish will ,ty. D p ? . ubmitted to the Department and a written guarantee will be furnished he ow nor, e hi�'iodcofw years 1mme0iately tollowingTttiedate of the issu- - rt of said sewage;. disposal system; during pe "< e in. good operating cond�t�ori• any pa of the approval of the Certificate of. Constructwn Compliance of',the briginal'::sysnce .with the tends dstrulestandtregu a'O s 81ofehe ePutnam be Located asandwn on the ipproved; plan and that said wall will tie' installed n accords my Department of - Health % 311 Sk- Signed" > Z Z•, Mph, 6rJ�� - I firs License No �, Address ROVED FOR CONSTRUCTIAN: This approval expires one year from the date issued unless construction of the buildin9 has been undertaken and ice_. cable for cause or may be amended or modified when considered necessary by: the Commissioner Of Health. Any change or alteration of construction ; sires a new permit. Ap sw /proved for disposal of domestic sa Mary $ag a /or rrvbte water suDP1Y QnIY• s V � Title -7 BY 4 q., Zip ..... .... . . tus-,,ls, jo! q0fi 'tho sqW00 f , 4 disposal - , was T _y t IC �b' iefore, i was co, constructed pldhil,�,,d-qt�' h as y system ..em W- t Ver- a constructed jr(666'rdance ed. '0,�'eF. The'' syttem'. s 0 with, all the - -,rujas, and',;*regulptions',df the 'Putham' Coufr.1, - ' f* , w - - � " , �� -, - .1 1 1 .. AREA.:1016 6 acres' - + �FpF NE11 yQ� �'' / �tA / � f I I -H Pdit,M y� S. 29 t W4': -462;� Yy IF lz� 7 ev, 'K SHORE 'ROAD A ✓e §0 1 7" 4 ei' as k, �V - A -- r t 1 Plan based Jon survey by Poulh 8 Walden LS f( i{ f a <+r, �- 1 Ra 1 I y r U. u41.>fiyrx "K °IU �.i� J yJSgaJVx Y �k �e d•�u7 f"Vik$i `u h�'' ,f t a ss°Act �i r p= rSx 9 f r a b nk' y w ,, "i y4 G v t 4 b d] i d •'ice ,r � f '�� �� -j a y b �V �M� k��}�v � ry. �,J� s4v y"^7jaR}»� iF __• � r r _ J. t•'. ` z k . i64 1 of �Y SEPARATION DISTANCES IN ^FEET, 8:. 9 10 ,11 12, , al '- 14 I IS -1 16 Ix Ib I- ..,'�9,' be- PUTNAM COUN'!'Y DEPARTMENT OF HEALTH DIVISION OF ENVIROV,41MAL HEALTH smyICES vo y�i 1 Owner or Purchaser of Building Section Block Lot tilding Constructed by I,orationM .- -:��3zreet j& L R— Micipality &3t Building Type Subdivision Name 7G 3 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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'yamendment_thereto, and in accordance: with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner ;!hs. successors, 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 approval of the "Certificate of Construction Compliance" for the sewage disposal system, .or any - repai -rs made.- by ...m'� tc stick. systi m' except ,where . the failure to operate :properly - is cazsed by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caased by the willful or negligent act of the occupant of the building utilizing th system. r v Da ed this _ C day of 1 19 D It eral Contratkwl °er) - Signature Cc,�ration Name (if Corp.) Adress re. 9/85 rid Signature Title ( " � 4�(1O ac. ��Cwv M V�4 _ Cort)oration Name (if Corp.) Address R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 7- iz0 )56 Re: Prope'rtN---N-q Located at RA�k I�KZZ0LIQU e (T) Q �1a�lev� Section 1 Block l Lot 9 Subdivision of � c� o� �Zo dg"n ' rtOA Subdv. Lot # Filed Map # Date 1� 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 not.ed.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. �cohnection 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. Very truly yours, Signed �~ Countersigne caner of ro #ty P.E., R.A., Address Address Town 10 51C Telephoned Telephone ` �� In 0 G l' v� ti DEPARTMENT OF HEALTH - DIVISION OF HEALTH FIELD INSPECTION REPORT DATE: > aroldo I ��4�1 ".__'__INSP_. _BY: r� l (Name Ownex) (Street Location) INITIAL SITE INSPECTION &)A19 In YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ......................, <...,. Must trees be removed - 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 ............................ D. H. 1 Lot Depth _ to G.W. Depth to rock ft Soil Descri tior 0 ft. 12 ft 3 ft. J W! LE?k� �C 6t 9 ft. D. H! 2 � Lot Depth� G. W. Depth to rock .Soil Description 0 ft 3 ft 6 ft 9 ft 12 ft FINAL SITE INSPECTION INSP. BY: r House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... Rosen allowed for expansion trenches .............. Over 100 ft. fr= watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maim twined from property line and 20 ft. frcen house .... ........................ . ' Distance well to SSDS (ft.) <............ <........ Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally E from trench..... .. .. .. ......... . ... ... ..... .... Boxes properly set ............................... il �ould surface runoff from driveway, roads, l .grouuRd surface, etc., channel near SDS area... . `oes Lot drainage appear OK in area of SDS........ ML GRADIC OF SITE ACCEPTABLE .................. D. H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. COMMENTS . PMAM COUNTY DEPARiUM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS -- • • • •.•.�I lul�l►ih • I ICI � i YC �_ ®M IA. W 6OR! S. ®0 �- rmm e� ME = DATE REVIEWED: 5-2 -b(, BY:� ,oV71N Permit Application (- Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data -Two- -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown; gravity_ flow,suff...size ... If Pumped Pit `& D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL, Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same , W 1) 1k*,4 EEt (CON • C DO &I ITAR ',TO: I DZ# V�j #a - 9 •1y 1 • .DESIGN DATA SHEET -SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner V_c&ml- '5\x- -z z o o Address 7 17 Located. at (Street) Sec. 10 Block t Lot 9 (indicate nearest cross street) Municipality Watershed 4J�� SOIL PERCO=ON TEST DATA REQUIRED TO BE sLmmr= WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Testy 3S HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run No. Start-Stop Elapse Time Min. Depth to Water Frcm 'Ground Surface Start stop Inches Inches 'Water Level- In Inches Drop In Inches soil Rate Min/In Drop 1 3 4 2 -4 .3 To 5 z 2 3 3 4 _4 2 _, 3 5 rev. 9/85 Metts tof I -are bbtAb for „revi� d repeateff at same--depth--untn-apprcv-izat�elj equal -soil rates bd "at " each 1perc94 t*_tm arements to be made frati top of hole. 'T DEPTH 1' 2' 3' 4' 5' 6' 71 13' 14' � INDICATE .LEVEL -AT, WHICH GROUNDWATER IS ENCOUNTERED 0- - _ - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -- 0 `- DEEP HOLE OBSERVATIONS MADE BY: F. Zw�z DATE: 3 g3 0 DESIGN Soil Rate Used Min/1" Drop: .... S.D.. Usable. Area. Provided No. of Bedrooms r..•... 3 Septic Tank Ca c pa tY.......__ ooy_......gals._...Type ...carer Absorption Atea..provided .By. 3oa . L.F. .x 24". width .;trench__;_.. Other Y Name ;�rAet ; - _Z Signatures 44 ......... A Address 29.z Mai �� SEAL THIS SPACE FOR : USE BY EiEALTii ' DEPAR'IlT ONLY s" r r:: p • NP ROFES$j4 �. Soil Rate Quad Appr m f fi,%gal, =1 %y Dite h' .. { •y ?•- a. a.: �fi tq iii {�n r'a.fa a r�.