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HomeMy WebLinkAbout2637DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -33 BOX 22 FM xmm in IN! 6 -1 ly 1 jr- r z ' r �J i I [, I .r :, J6 : ■• ■ IN 02637 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date -701 Re: Property of 'W6-5 lek� & Located at (T Subdivision of n,,- /�ie!e d' Section5 Lot �2 Block Subdv. Lot # Filed Map Pate I I Gentlemen: b 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 r-mi" or or systems in conformity with the provisions.o 4-5 0 147, Education Law, the Public Health Law, and the Putnam County Sani- 0 tary Code. Countersigned: :,2 7 2- -4 Address Telephone Very truly yours, Signed Rd 0 er (of Property Address A1,1V /0 1'17 Town Telephone 0 r � _ t• r g Jr ilfr ePia by wt fi t7ti Si b19tt t! 4L ­ 3, oualoy bciorr ccr f3;�, t£ nr c�n•,.ounfc7ri t ;2 �.._ TF:f �zC� }J � ..._ E W3.aJ'u, Ls a w 3a.,•t IT t ••.i a»} 3.e60 East 2 3 4 h S . r a . 1ro !.-K , y 0 4 l 0 }R:.;� "°-....... :(t:s ti urree tl� .. ���`..�,.. .......... .,........,., ¢i9f'A. ✓:v+csrj �......... _...... i F#L?D�I �YiC. l.»i 3dElifitdlvkN7 a1TLAfe Jr°aTm7D —f CAIR - t�€��,rLT CQA'pzsc< CAB"! �,tytT p �i3iAfY: AIR P.XC..ZSION PE &rt1551CAi' !' ) tSao:.i.;. vk3lsfral Gt ailfxrinthe3l t.rs3� -ri;• Pf9,f702 .. �..�... .. -.. C " :_ ., y. r..,..1 L:'fYE �"5l"�:- .- ..,:...,...•,....,. i 1, «MA >�Nw G,+: _ 3Q✓� 6 {3 �. �_ I Tt?READE, L�1 v+ "` -LDE7 i '� YES NFU I . �f Tf5 � j PdC1 jy `7cQtIE »' G,. ➢:iA. �'ItFL9 {G..P.At.% 25 ?j :Rcxr4,)�n Eel:D SUSPACf= • >tAit�;�cac3ly it¢t7 Dt1Rtl�G Y1E1G TEST //lest) pCp1�3 9f lr ornprt Ord Wle1} c +4- 20 In feet bale- iand xur:u_r: 365 1GE: €ir °.k"ti::Yi Ly °E'1 iLJ ,z 4 lF iM.lr;: �� .� Gta„uETf:P (Sncneaj �"" � GfAYE: S :i:� l:n:ncsl f$'JM'ir.gelj����'�iC t+r:a:)..�.�"•..... If GRA:NEt t 0 ;0"'tf4tr of wttf inriuding t . FO MAT1Dt1 L�ca:.S T!�r! 3satch aaatr racc:ro� cr •! «..rn Crnr�nG:1. fa,�t l:asf Y.. _ rwo p9rranonr fa n�m�rxl. - - .. - P' y � a k4 , � - �mmm.as.rfnpv�.+N1 .•s•wr»w:we..�.,r«.. .m.-v s•. >f n.r�,um� y� y - rrt 1 IU91f,'� 01 ati10.4n1 Qr tT1 �iJff C G `'t ;31 fiA y �"' ' `r t YS cusr �`z w7:...�:�..,... .�.»,..,., ......�..— -r anw- rtin;:,w, nw+.,� -•;;. ma -c.. r:amr:,rrr...r� »,o. nr ,)s ya✓'r.�:'Nx - - ~ ::, i° iS. t x s.. ' y-'t ^ 1... °_• i . t''°f��.,e ?,4 r, 7z5 Owner o urc aser of Building Section Building Constructed by Block .� �/�.� ./1'%11 � /�����• �d � 4' I Location /- Streets/ Lot �i A7 7G rrl d` �/�i 4_ Municipality / Subdivision Name Building Type 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- _ .- -. a-tioxr -of the D2recta � o €- the <Div on of En ronment�a -1-- - He_a -lth- .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 of the building utilizing the system Dated this day of Signature Title h I`C) Corporation Name if co,p'. 41 c am Address- - - - - - - - - - - -,��� r - - - - - - - - - - - - - - - - - - THREE ( 3 ) COPIES ARE REQUTA1ED=,WI-TH;r-THREE ( 3 ) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION• WILL B9 "I'S SUED. PU i IN. AM (7 GUARANTOR IS REQUIRED T�L �T �OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health �� . � �:_ °�iy�.: .t. Vii' w.-^�'�2O - a ,.w �;+a x � fi _ - PUINAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMERML HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SDU GE DISPOSAL SYSTEMS _ FIIkL,D INSPECTION REPORT DATE: INSP. BY: (Name'of Owner) (Street Location) INITIAL SITE INSPECTION I YES I NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ............................ Must trees be remved - 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 Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 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 �0 0 ft. 3 ft. 6 ft. 9 ft. 12. -ft..J DATE: 3 - 27- FINAL SITE INSPEC'T'ION INSP.BY: YES NO CHI'S House SSDS located per approved plan ............. �! Length of trench measured 81-11-LED Width of trench average Slope of tile line and trench acceptable......... ✓ r Roan allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded .......... • .... ........ 10 ft. maintained fran property line and 20 ft. from house... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... " Boxes properly set......... ............... To PC' �.4 L- Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRAM OF SITE ACCEPTABLE.. I .. �17 .PIE CIIECKC 1AST. Date: Insp.by: INITIAL SITE I1I3PECTION y Yes No Comments ,Property lines or corners found . . . . . . . . . Can estimate house ]_ovation . . . Will drivcway need Cut <. , Must trees be remov"d -note these . _ Is deep hole represt;nt-ative of entire SDS area Additional deep holes needed. . . , , . _ -- Sufficient SDS area available considering - driveway cut, house: location, separation . distances, etc. DEEP HOLE DATA . Depth: ldater elevation: - - Rock elevation: Soils d.escr_i.ntion: Date : i 3 -1.3 PIS` AL SI - ] DIS P 1OC`i'I()�: Insp. by: G House located uher.•e - sholrn on approved plan = . SDS located whiere approved 7 :length of trench mca s ured - Width of trench avera 'se _ Slops of the line and .:.trench,. acceptable .....�_ L _ Over ,50 ft. from swamp, lratercourse Idatural soil r_ot . stripped or SDS area '— - _ - iuunecessarily graded , 10 ri t m-a intained from prop . line and - 20. ft . from house . : . . . . , o Separation of trench from house, well :--etc.—follows plan - 'hhuiiber of bedroo-ms checks . . Stone::,' brush, * stumps, rubble, etc-*. greater than 15 ft. from nearest trench . . . . . . 25 Pt. of peripheral soil horizontally from trench. .. . . . . . . . . . . . Junction boxes prop ,rly set Could surface run 61 "f from driveway, roads., • ground surface, etc. chaiulel near SDS area. . . . . . . . . . . ° Does :l.ot drain:.ige app-ear 0. K. J.n area of SnS _ FINAL GRADING OF SITE ACCEPTABLE o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - ,-:......_:-COUNTY OFFICE -BUILDING;,= :,CARME, L;—N- Y~._.. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address -5410 ae 23-0-� / .0 �✓ - - Located at ( Street fee -,) o.v.�� Sec . ,&' Block Lot n ica e'neares _cross street), Muni cipalit Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3 1I- � � l// %/ �& / s`' -1-70 >i3 3 4 5 Hole 1 . Number CLOCK TIME PERCOLATION PERCOLATION TEE apse Dep o a er. Water ve . No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 3 1I- � � l// %/ �& / s`' -1-70 >i3 3 4 5 1 . 2 4 5 Notes: 1) rates are for review 2) Tuts to be repeated at same depth until approximatelyy equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. ­ DEPTH" * - G. L. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUYIMED -7 TEST HOLES HOLE_ NO.­ ma XG. HOLE NO. 611 12" 18" 24" 3011 36" 42" 48" 54". 6oll 66" 6 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ..INDICATE:. UW.j, TO TE RISES AFTER _,BEING ENCOUNTERED �y o��J�g LEVEL R --M3TS-,1V1ADE, *BY* Z DESIGN Soil Rate Used_.,,7 Min/l"Drop: S.D. Usable Area Provided No. of Bedrooms---.3 septic Tank Capacity /e9o-e Gals. Type,� Absorption Area Provided By L.F.x2411 width trench. Other iName \, j v_5 .:,> w ) I I vow Signature_ Address THIS SPACE FOR USE BY HEALTH, DEPARTMENT ONLY: Soil Rate Approved_ Sq. Ft/Cal. Checked by 4 W4,;jl e7a . gu 'CA 0 �.A a t e 30 \�� PUTNAM COUNTY DEPARTMENT OF HEALTH �� , —,3 j r � o / 1 Division of Environmental Health Services, Carmel, N. Y. 10512 Permit # CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM � r+'► �" /��-N / r✓ / /�� /�l�. - Tax Map a J _ Town or Village J LocAterl_ cat _n. Block 6ol Separate Sewerage System built by ®ot� .In e Consisting of %C?af�Gal. Septic Tank and Other requirements Water Supply: /Public Supply From _._. Private Supply Drilled By Tax Map Lot # 4_YLL Subd. Lot # Address .7 3 Y X 4 2-4't ' r`e',7-7E %A=S Address Building Type z 4- r' ; No: ­ofl Bedrooms: Has Erosion Control Been Completed? Date Permit Issued - W. G"Zo6z C1vomVek I certify that the system(s) as listed serving the above premises`were,construated essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules'an4,,jegtii;9E� ups in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. e�;;' °� (i+'•'.{'f,['�r�m�'�,a� >` V a Date C rtified,byP P.E. RA. Address Lice ) nse No. Any person occupying premises served by th above system(s) shall promptly fake sub aetioo's tlnay b necessary to secure the correction of any unsanitary conditions resulting from such usage. A roval of the separate,,sewerage system shall be4ro,J°ne mull and void as soon as a public sanitary ewer becomes available and the approval of the private water supply shall becomi,ri lif and +,yokf when 4 ". c water supply becomes available. Such approvals are subject 'to modification or change when, in the judgment of the Co "Aissione "of i jeelV ych revocation, modification or change Is necessary. Ci/ (V(O0 ' ` d Date e� Title Rev. 9 -81 1 ,� 1. 1 CONSTRUCTION . PERMIT Located at / 4✓�/ subdivision Building Type G - PUTNAM COUNTY DEPARTMENT OF Division of Environmental Hea /th Services, Carmel HEALTH Permit N. Y. 10512: -.: I.OR Sg,W.A 3E DISPOSAL SYS`T EM' _ S f i Town or Village� b Tax Map J S Block f Subd. Lot '# s Lot (� e Renewal Revision Number of Bedrooms _-.�� Lot Area G� %�•, Design Flow a /P /D � �-- Separate Sewerage System to consist of ✓� f t ls'' To be constructed by Gal. Septic Tank Water Supply: .P,ublic Supply From -_ Prlvate Supply to be drilled by Address Other Requirements Date Of Previous Approval Fill Section only P'C• N• D. Notification Required and 3 e,-- sr Address _ / �� �✓G�C� 1 represent that I am wholly and completely responsible for the design and location of the L ` above described will be constructed as shown on the a County Department of PProved Of there to and in accordance with the standards rules an r be wbm(tted to the Health, and that on completion thereof a (). 1) that the separate Sewage Department, and a written Certificate 9 disposal system Place in good Operating guarantee will be furnished the owne►, Construction Compliance °� b egyla ,ons o ante of the 9 condition any part of said e u nam approval of the sewage di oral wceessprs, �}(�}#i�y' in; of Healthwill Will be located as Certificate la Construction p system tluring the �Vr ° i9M "SY,�}h builder, that said builder will shown on the approved plan and that said well sW,yl Hance o the original system anyw par t 9 Bdi tel following thedate of the issu- County Department f H ."�� S cal h. accordance with 8 t'a ` , p' %th8t the ~drilled well described above Date / /� ifi - C". fea aril °oegu iaTf*on- s of the Putnam APPROVED FOR CONSTRUCTION: revocable for cause or may be amended requires a new na—f Date Rev. 9 -81 P.E. R.A. has been undertaken and is IV alteration of construction ��-f l t j, , .r 4 Jo 1 j We, 1I too -,3 -33 Putnam County Department of Health Division of Environmental Health Service Approved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department. ��n �Cema 4794F ghature &Titl Date ^ '.! . .,.Fx •�' 'A_y"°':. pid L. N-t -. 4" , 'te.+".... ..r ,%I'J . aj/,,%�(.Ot°,Y ".f (,fry/ ../ i �" F�. r' ..dPF:d .f�f•�! �^Ed! � � r �. .i"' �f.� .. OF REw ♦owof PL�'4A4r _S" :4.k /.,. . :+ . 'j ,r O 3 / '.f .,1� tl',•d' ehY s+ 7 :� `�' .i y-'o �i4,V A� %�e /..� r�t✓.t.�F3 7'�Teii.J`r� � / h 4C C.G� G.�.�Yl /:�t'- /!� Es�� s�/ .Sfn9 rx�o ca�s r•- a �a vv � r'.:J � �a .�' cr,�.s ,4/-.-. - / - L _. 1 - J s 2 �4 .90 /Q 00 // S— )o 3 -,3 -33 Putnam County Department of Health Division of Environmental Health Service Approved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department. ��n �Cema 4794F ghature &Titl Date ^ '.! . .,.Fx •�' 'A_y"°':. pid L. N-t -. 4" , 'te.+".... ..r ,%I'J . aj/,,%�(.Ot°,Y ".f (,fry/ ../ i �" F�. r' ..dPF:d .f�f•�! �^Ed! � � r �. .i"' �f.� .. OF REw ♦owof PL�'4A4r _S" :4.k /.,. . :+ . 'j ,r O 3 / '.f .,1� tl',•d' ehY s+ 7 :� `�' .i y-'o �i4,V A� %�e /..� r�t✓.t.�F3 7'�Teii.J`r� � / h 4C C.G� G.�.�Yl /:�t'- /!� Es�� s�/ .Sfn9 rx�o ca�s r•- a �a vv � r'.:J � �a .�' cr,�.s ,4/-.-. - / - L _. 1 - J s �. _.g.. .. _... -�. —.� ... d t t 9 e 9 t i ... _..¢_. r -.