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HomeMy WebLinkAbout2399DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -20 BOX 21 1 if - 1 IN r .. E L�., -� mil] PUTNAM COUNTY DEPARTMENT OF HEALTH Permit a Division of Environmental Health Services, Carmel, N. 0512 CONSTRUCTION PERMIT FOR `SEWAGE DISPOSAL SYSTEM LG Town br village Located 8t ^,'�� '�f / /_ /�� :y"y G� Block �,.. Lot Tax Map Subdivision ' -� ✓� �`}�r��Cv �� ��'f SSuubd.`Lot # +��/ ! Renewal _ 0 Revision _ (] owner /Address -7 C�i� -Jf� ..:e-f ..� J, r' ! +• ^'i� �-J d ✓ 1 Date Of Previous Approval r � r Building Type ;`^� Lot Area i11 Section only ❑ Number of Bedrooms Design Flow c /P /D C3 P.C. H. D. Notification Required Separate Sewerage System to consist of /, d3 v, Gal. Septic Tank and '� r— 2-- To be constructed by Address Water Supply: Public Supply From b Private Supply to be drilled by N Address � Other Requirements , 7 , � LI /3 I I represent that I am wholly and completely responsible for the design and location of, the propose system(s); 1) that the separate sewage disposal system ru , above described will be constructed as shown on the approved amendment there to and in ae4oreon%wiith A e standards, rules an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of ConneGi tjQ Cotnpl;iaAZ4- ^.satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owplir,''hi{,s' > ►s,�heijrj%r assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system durin$pthe p ,fotl'o'fj KfQ 4�) ye4r,�immediately following thedate of'the issu- ance of the approval of the Certificate of Construction Compliance of the origilj'at,s��!!stSyri'or any repaJr ther to; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed I itccordpi%e wifhiRhe stbn ards;, rules and regu al one s of the Putnam County Department of Health. �✓ f �•,� 43, � Date i / �/'C! G �/ Signed ./,4, P.E. R.A. y Address rya �•., �.:: �::�:: a License No. APPROVED FOR CONSTRUCTION: his approval expires one year from the date .11 i' ,es �structi ten' of the building has been undertaken and is 1��i:, revocable for cause or may be amended or modified when considered necessary by the Cpm ,ssif;;o Hpa'1fh. Any change or alteration of construction r. requires a new permit. Approved for;disposal of domestic ita age, nd /or! priv e.wa�e'1'' - ,p --p1cy only. Date D '✓ a � {/ By 1 .�—�� V�o —_.... Title Rev. 9 -el i r'JANCO PNV°I;RONMENTAL S;ERVICE.S'll .INC.y I UNITY STREET AT ROUTE 376; P.O. BOX 10, HOPEWELL JUNCTION, NEW YORK 1253. (914)22 -2485 NAME: ADDRESS: SAMPLING POINT Kvc -GC/ �" /U` �'v -7f TREATMENT: CHLORINATED 0(' PPM); SOFTENED 0; OTHER-0 SOURCE: DRINKING WATER ❑' WASTEWATER EFFLUENT ❑ OTHER COLLECTED BY TIME DATE �G7! ❑ APARTMENT COMPLEX "0 INSTITUTION ❑ PRIVATE RESIDENCE ❑ SWIM POOL ❑ BEACH ❑ MUNICIPAL O RESTAURANT ; ❑ TEMPORARY RESIDENCE ❑ CAMP O' NURSING HOME ❑ SCHOOL ❑ TRAILER PARK' ❑ FARM LABOR CAMP ❑ PRIVATE COMPANY ❑ SEWAGE TREATMENT PLANT ❑ OTHER TOTAL COLIFORM COUNT M.F.T. PER 100 M.L. ❑ TOTAL COLIFORM COUNT M.P.N. PER 100 M.L. • FECAL COLIFORM COUNT M.F.T. PER 100 M.L. ❑ FECAL COLIFORM COUNT M.P.N.• PER 100 M.L. • FROZEN DESSERT PLATE COUNT ❑ AGAR PLATE COUNT { PER 1 M.L. J Water Supply: Public Supply From y Private SuPDIy Drilled BYG'� "— Address Building Type No. of Bedrooms " Date Permit Issued �0 Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed sea y� wn on the plans of the completed work { copies of which are attached), and in accordance with the standards,, rules and regulations' c d °w the filed piani and the permit issued by,the ooeo" Putnam County Department Of Health, P.E R.A. Date Certified by Address. �. { Cleanse No � Any person occupying premises served by the above system(s) shall promptly; taki s1i At�tion°os ay be neceuarkto secure tho eorroction of any unsanitary• conditions resulting -from such; usage. Approval'• of the, separate sewerage system,ciQIP,)sewcon�PAM Land voldaasDsoon as a public sanitary tower becomes available and'th® approval of the private water supply'shall become nul d void.xihm �a pUtific �u)at o3ugPly becomes avoilablo Such, opproya.is 'are subject, to modification or change when, in the Judgment of this Co mis n of Hegltt(; <w4h'r 1 cotlo'n'mali4ieaition or change .ls,noeoseary. •+d, G ., Date ey • Title _ _ • Rev. ,9 -81 3/71 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 NAME ADDRESS OWNER LOCATION (No. B Street) (Town) (Lot Number) OF WELL n J DOMESTIC ❑ ESTABLISHMENT ❑ FARM BUSINESS PROPOSED ❑ TEST WELL USE OF WELL ❑ SUPPLY El INDUSTRIAL AIR ❑ OTHER CONDITIONING (Specify) � DRILLING n COMPRESSED CABLE! OTHER EQUIPMENT LPL ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER SHOE WWM CASINGTJU ED? O DETAILS (n 1 ` 7[ THREADED El WELDED YES ❑ NO YES NO HOURS G.P.M. YIELD (G.P.M.) YIELD TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR ( 10 10 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well LEVEL OVe l OWin 00 in feet below Land surface: 5451 MAKE LENGTH OPEN TO AQUIFER (test) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at hest FEET to FEET FORMATION DESCRIPTION two permanent landmarks. 0 20 clay and boulders 20 30 granite casing to 30' 0 4 granite i If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE .. '.. DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 11/20/ 8 s1 ^ r., i i Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type Section Block Lot r Subdivision Name Subdva 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 Director of the Division of Environmental Health 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 day of dp 19 L?4/ Signature 7 Title Corporation Name if corpe 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 Insp.by: INITTAL SITE INSPECTIMT i ° " Yes" 110 Comment Property line- or corners found _ Can estimate house- location . Will driveway need cut hjust trees be renoved -note these Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . ..J Sufficient SDS aroa available considering driveway cut, house location, separation. distances, etc. . . . .. . DEEP HOLE DATA D3pth: Water elevation:' - Rock elevation:- Soils d.e scr_ ,,Dt.l on: Date • /-T7 -3 F7, FINAL ITNISP EOCH0� Insp, by, A1G) House -located where 'shoi,,n on approved plan SDS located 1- Mare' approved lei-Z. th of trench measured QX35 .1 Xq5' W id .1i of trench average �2 y Slope of the line 'and trench. acceptable _ Doom lowed for c�gnsion a trenches . . . Over 50 ft. from swamp, watercourse - - Ratural soil r_ot . stripped or SDS area - - imnecessarily graded . 10 Ft. maintained ' from prop .,line and „ 20 f't . from house . . . . . Sep�� ration of trench from house, well etc.-follows plan . -, -. -:- -- ,------ - - - - -- - -- hhui)ber of bedrooms checks . . . . . _ - -_.._. ._.___ ---- ,- Stone::, : brush,,' stur:ps, rubble, etc,. greater than -15 ft . from nearest trench . . . . . . ` 15 ht. of peripheral soil horizontally from _ trench .. ... Junction boxes properly set Could surface rLUZ off from driveway, roads; ground surface, etc. channel near SDS Does lot draii-i.-iga zrtear O.K. in area of SDS FINAL MADING OF SITE ACCEPT -ABI Isox /SFr. '5©/1, rev —1 J i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Atl Located at���� // / /v.✓L%G� e' Section O Subdivision of " I e, In Y1 ) k i'l-0 Subdve Lot # el Filed Map Gentlemen: Block - Lot d Date OW 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 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. Very truly yours, NEV 'v✓ b �pNei Signed Countersigned;.'. �� 0 r of Property P.E. fi IVk �GlX / C3 A_ /3l) Address try Address t� Town �nnaa °s +oa a/ /J_ Telephone Telephone 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 %� .Co7G���1e�i� %'„/ Ael, c� Located at (Street �.�/ ,� Sec. �' Block Lotl7l /� ,„ indicate � nearest cross street) Municipality / Watershed SOIL PERCOLATION TEST. DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION xun tuapse i)eptn to water water .Level 1 No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2� ��✓ ��' 3 /_5`� 4 5 i 1 3 4 5 Notes: 1) Tests to be repeated at same depth until apppproximatelyy equal soil rates are obtained at each percolation test hole. A11 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. % HOLE NO. A G.L. 6 i 6" 12" 18" 2411 3011 , 36. 11 42" `t 8" 5411 r 60" 66" 72 78 f' 8411 HOLE NO. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Ale,-, e INDICATE LEVEL TO WHICH WATER LEV L RISES AFTER BEING ENCOUNTERED TESTS MADE BY �' — IS L4 V �i', p DateZI ul DESIGN 7 Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided _� Gael No. of Bedrooms -3 Septic 'dank Capacity AV Ca Gals. Type _ Absorption Area Provided By � L.F.x24" jb. width trench. OF pg�y Other d t "op000av -NaMe igna e E� as Addre ss_V' 01 4-v lvvn 14e, , THIS. SPACE FOR USE BY HEALTH DEPARTP2ENT ONLY: o ` A roaaoc Lump Soil Rate Approved Sq. Ft /Gal. Checked by ° °O0 °aaaa Date x 'itVA.PlOrp with of the ta. eat. to it: Putnam County I)epaxtmejlt of Health Jivision of Environmental Health Ssrvjc.e 42r') " : - cinforrmnos with ..,--.tions of the Sirnature 4 °I �I ....... ..... .......... O-A Putnam County I)epaxtmejlt of Health Jivision of Environmental Health Ssrvjc.e 42r') " : - cinforrmnos with ..,--.tions of the Sirnature 4 °I �I ....... ..... .......... S, 3 Ida oe 4 5PO ✓ 49 lino" o z 13 z9e e I . ... ...... 17 < of lato . A0 24 Putnam Realt z County Department of Vivision of Finvironmental. Health Servic Approved asnotsa fe- conformance with a icabls —jzmalss anj ht-Ic-s of the Cc'-t7 I�apartment. N-5;e,h