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HomeMy WebLinkAbout2673DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -1 -26 BOX 23 02673 ., its � 1164 1 T :, .� 4% 0 02673 TA�ILS -YIELD TEST WATER T�E;VEL- SCREEN DETAILS---' /feet BaMd or %street section block lot WELL GWNER name addrdss bit3� ox;-town name y or own TA�ILS -YIELD TEST WATER T�E;VEL- SCREEN DETAILS---' /feet BaMd or Sta t, Feet 'Give description of.`vf or ma*-z; ion penetrated, such" b-:`:peat,'_- II ln� d- S u r -f a c e silt, sand, gravel, tlay, hardpan., shal&,. sandstone, ZfiTi67----,-.mediI M. -s:e rw por )ate We!! Completed Date of Re tP&- signature DEPT. OF HEALTH c' - =:: ,p 'K� Owner or Pureftaser of Building i Municipality Building Constructed by` Section Location - Street I Block Build.ino Type �1 Lot •GUARANTY 'OF SEPARATE SEWAGE_..SYSTEM . h represent that -I aw*w' holly ­'and completely responsible for the location, workmanship., material, consStru�ction and drainage of the sewage disposal •sy,stem serving the above described property, and that it has .been constructed­ad shown on the approved plan or'. approved amendment thereto, and in : accordance: with the standard -s, - r..'u1eZ/ "and rye, gulations of the Putnam County Department `,of Health and. hereby gu, ranty td"the owner,, his succe.s- sors, heirs: -or assigns, to place;rin good operating condition any part of said system,.constructed by_ me which fails;to�._operate for a period of two years- _'immedia:te1y,.foll'owing; "the -date of iriit ial use of the sewage disposal"', system,. ,or: any repairs :Wade by. me = "to.. suc,11 sy -stem, except where the failure to operate properly` °i's caused by thee. willful or negligent act of the occu- punt.of the. , building utilizing the system.`;; " The_ undersigned further agrees to accept as conclusive the de- termination :of the_ Director. of the Divisioff of; Environmental Health Ser- _ vices•- :of.,the,` Putnam Comity Department of Health `as, to: whether . or not the - failure of the "syptem °to 'operate "was caused, b the willful or negligent act of•the occupant of the building utilizing Yie sys em. Dated this. day of 19:7,p, Signature Title If corporation, give name and address) - - - - --- - - - - - / THREE (3) COPIES AR•E\REQUIRED WITH�THREE (3) COPIES OF FINAL PLANS BEFORE CERTYIFICATE OF "COMPLETI.ON WILL BE. ISSUED. i GUARANTOR IS' REQUIRED ;TO, FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. bivisiori,of Environmental Health Services Putnam Count a.V tii�d n7o lth d JUN. i 21978 PUTf,•JAM Con -, � DEPT. OF HEALTH 'I'A "me O O nnh ti nq "'i -3 O OA;:, Se Sc,4 / E / "''SO' 2 T CUFAN 91 0 ­f 'Al A 4"01AA4.* M/.V. SEPTIC TRENCHES -rAtwr. T40,1-e /t TO F___ ZWV_ AREA= 3.52/ AC- THIS IS TO CEFT.711-7 THAT THE SELVAGE DISPOSAL SYSTEM WAS CONSTR-jr:-,­ -_j T';IS PLAN AND THAT - _ 7�yo7 IT WAS COVER- THE SYS?�,' ED OVER IN ACCORDANCE WITH ALL OF THE PUTINAM COUNTY DEPARTMENT OF HEALTH. 41� O j :�pp1; LEGEAID SE--rlC rAAo'.V' OUNCrIOAl BOX 4 "O /AM. -PER.-Pi • PERIC. rES?_ DEEP "Olfz' WELL 0"(D /Vor—= 51-WAG,- 01,TPOSAL lIvsrAtlArl, TO CONFORM ,TO SpeclirlcArloAl. AS SET FORTH; 'sr THE o-urAlAAf COUNTY OEPi.' OF Of sEpr/c D,--SIG" 042S61 SITUATE /Al -rl4-- ;TOWN oF Purm~ VAIUEk- RUrIVAAf COUNTY APP VE New YoR'<- -TcA4E.rA.S SNO.4ovv OA M.'MA RCW 9, 1977 W//- I 1AA4 F. ASSOC. JUN 1,9 197PI 0 S 10,V S 3 2. Y. Y' 3 27,0' sf. 4 7 AREA= 3.52/ AC- THIS IS TO CEFT.711-7 THAT THE SELVAGE DISPOSAL SYSTEM WAS CONSTR-jr:-,­ -_j T';IS PLAN AND THAT - _ 7�yo7 IT WAS COVER- THE SYS?�,' ED OVER IN ACCORDANCE WITH ALL OF THE PUTINAM COUNTY DEPARTMENT OF HEALTH. 41� O j :�pp1; LEGEAID SE--rlC rAAo'.V' OUNCrIOAl BOX 4 "O /AM. -PER.-Pi • PERIC. rES?_ DEEP "Olfz' WELL 0"(D /Vor—= 51-WAG,- 01,TPOSAL lIvsrAtlArl, TO CONFORM ,TO SpeclirlcArloAl. AS SET FORTH; 'sr THE o-urAlAAf COUNTY OEPi.' OF Of sEpr/c D,--SIG" 042S61 SITUATE /Al -rl4-- ;TOWN oF Purm~ VAIUEk- RUrIVAAf COUNTY APP VE New YoR'<- -TcA4E.rA.S SNO.4ovv OA M.'MA RCW 9, 1977 W//- I 1AA4 F. ASSOC. JUN 1,9 197PI 0 I1*� � a PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM fl9AIhM 'V,4LC.G ll Town or - fie Located at/° Block. c / S bdivision Lot r• Job u owner Building Type /r J(�t�' Lot Area A'SZl 4(, -- Number of Bedrooms � Design Flow c o` Separate Sewerage System to consist of �J 910 l2 Gal. Septic Tank To be constructed by Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements t'/ ZAddress 2/ �� , 12 zdd Total Habitable Sp /ace / 9Q irk Square Feet and %3 %�� r ki Addne-U Jur I represent that I am wholly and completely responsible for the design and location of the prod sed syst s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordapce w i the standards, rules 'an regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Co pliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his suc essors, heirs or assigns by the builder, that said builder will place In good operating condition any part of said sewage disposal 'system during the perio of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system Ir any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed i acc dance jyy'���ith the andards, ru es and regu a ons of the Putnam County Department of Health.` — �p % � P.E R.A. Date Signed 1 Address A) V License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construct4 of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Comm' 'oner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic Sa sgWage, and priv a wa r supply only. Date .� _ BY °^� dkA_ Title PUTNAM COUNTY DEPARTMENT OF- HEALTH DIVISION OF ENVIRONMENTAL'HEALTH SERVICES Re: Property of , rV ����- • Located at Section 57 Block Lot o Gentlemen: This letter is to authorize /L� /t_ �, %Z` 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 gapers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity.with the pro- visions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code.. �c •f Very truly yours, h� \t F. ICS i, Signed • , � Eti ;�..-. � . II' , � Vim` -^.'_� \X.✓ Owner of Property At F� PROFESSV%P � Address Countersigned: �i2iliLl� , Xt.�,� _v3 Telephone p•E•, , Address Telephone r 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 Lllf lS 670L Z)67 Address 2-/5? __ro, A010, 44)b Located at ( Street ,¢,+qtr • /cc f D Sec . 6-7 Block Lot ica e nearest cross streeET Municipality. P(} j ) am j%"at Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse DepthtoVaiter a er ve - No. - Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop.in Min. /in drop Inches Inches Inches k-3 s 3 2 10 ,,a l ©; C� a aka 2%Q! /0 %D; a 90 ag�� 3%0;4/6 36 a3 / 5 1 q., l0' 1 3o A 3 as /0,0 3 P: V,? 30 Va 4 7a; �� 1a: 8 30 3 0 ?S a 14 ��. 3 k-3 s 3 2 10 ,,a l ©; C� a aka a /a /w. 0 310,'d )l,aq 30 03 ii; 5 Notes: . 1) Teets to be repeated "at same depth until approximately 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. DEPTH 6" 12" 18" 24" 30" 36" 42" 48" 5411 60" 66" 72" 78" 84" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO.� HOLE NO. "?/ HOLE NO. r INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY /) Z L 41f} M ZE 1 L 6R Date -7- % :2 DE_ IGN ., . .Soil Rate Used�MirVl "Drop: S.D. Usable Area Provided �S a0o SF No. of Bedrooms — j � Septic Tank Capacity fh Gals. Type .( ?t1v Absorption Area ded Prov *, L.F.x24" )6"— width trench Other Name Aj )L L1 A- /y! F. 7_,!51 LE/2 6ignature -- Address M) # q jqyAUCo" 12o 4b SEA y�P� PM F. 2�, 01 H o Pa C.- n V 1CLS THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: I Soil Rate Approved Sq. R /Gal. Checked sFO �s PkOFESSIO �l M m ml 0 ..�. Z zt tiu W� fc, 2 V 0 W 1 J 4 Z lu 000 6F tb� M,G2, rj 2 h ¢ ° �l M m ml 0 o� 02 5 cri M / N i 1p h 100' Y, `00 is e CS•o ors+ a• � s� 6p2 0 410 00 0 a� N o h .L2 9s2 M 90S Ld CL ) 6- V) n �I V � V Q F � o o° CL W y) Q L W CL %W 2 ; 3 e= w u e r y J1 IS � S �•.1� .. s f d 1L L cANO � uj ai � F p4� � V o� 02 5 cri M / N i 1p h 100' Y, `00 is e CS•o ors+ a• � s� 6p2 0 410 00 0 a� N o h .L2 9s2 M 90S Ld CL ) 6- V) n �I V � V Q F � o o° CL W y) Q L W CL %W 2 ; 3 e= w u e r y J1 IS � S �•.1� .. s f d 1L L cANO � uj ai � F p4�