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HomeMy WebLinkAbout2706DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -16 BOX 23 02706 1.6 JIN Ilk is 02706 { ` PUTNAM COUNTY- DEPARTMENT: OF HEALTH / r Division of Environmental Health Services,• Carme% !V. K. 10512 t . CQNSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM -:, LL 0-K Y 1 T wn or. Village "Locate at C.� J1/�,: !J o%L_ off/ U.4/� , / Rlock _ _ ! �. Sub'di'vision b i. Lot a! J � t'O,wner �d G.14/L'l Address ` �/3ECoa p ^ Bwlding TYPe ..�C:>= T���l`Tl�� +Lot• Area Number of Bedrooms Total Habitable Space �? �_ �2 ^-+ Square Feet i 'Separate.- Sewerage System to consist of - 470a Gal..Sept;c Tank` pineal feet X width trench �I S To be constructed by �1���( CTi� 6�C Address 7. x .Water Supply: - >Public.Supply !From' - ,P.rivate- Supplyf .to be 'drilled ,by Address ('!L Other Requirements �EP!' Q8 /i L., ' 1. .11 represent that!I am wholly and completely res and location of the proposed „system(s); 1) that the, separate' sewage disposal system above'Aescribed will:be constructed as shown )$ t'6ere to and in accordance with the standards, rules an regu a ions or e Putnam County 'Department • of Health, and that n4 fi6te of Construction compliance” satisfactory to the Commissioner of Health will f I be submitted to -the Departmeht, and a. shed the owner, his successors :heirs or assigns by the builder, that said builder will place in good .operating; condition any i is em during the period of` two' (2):years.immediately•following the date of the issu- ance of thela'pproval .of the C'eetificai w on tan the original system or any,repairs' thereto; 2)'that th`e drilled well descr;lbed above . will be•located.as� shown on the approved Ian nda _ I'be led in .a ordance •with' the Standards, _rules' and regula i�f -the Putnam t County Department of Health Y ) r Date ^T o. *. �'� T ne - - 'P.E, R.A. .. �. License No APPROVED FOR CONSTRUCTION Th`is.ap F:ie from the date issued- unless construction of the .building has been undertaken and is revocable for cause or may be amended de mod ifi d necessary by', the' Commissiorier.•of :Health. Any. change or, alteration f co truction I requires Ya new - permit. . Approved for disposal of dome is sa itar� sewage /or private water. .supply only., i % 1 Date' CO/ / , / Z % BY Title t � ___ PUTNAM COUNTY DEPARTPaN T OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date',-- l� Re.Z. Property. of 1`ZA _4�4 Z—' Located at L, AI4,r , I LGo bii l yA-a _%6 *n1 n� .f" �� 'd Lil Gc M 5-7 Block Lot -" Gentlemen: STANLEY 1. �.ANDER This letter is to authorize e a duly , l'icense,d professional engineer, or- registered architect. (Indicate) to .apply for a Construction Permit._ for .a separate. sewerage system; to serve the; abo. v- .noted.property.in.accordance with the standards, rules .or regulations as promulgated by the Commissioner of the Putnam County Department of. Health, and to sign all necessary papers on my behalf.in ­-.i-,ion o?? i► ::tb th' e matter anti to'. `uDervise t''ne 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 -� tart' Code. Very truly yours, Signed of. Property p Co ersigr_ed: Address P.E.; ., ,_ 327�a (Seal Telephone LEY 1. L.ANDE �g d rvX 267 N 1 1050 'IPA, i A 245 -2645 \ ` Telephone ����e No. s��z° r r PUTNAi1 COUNTY DE?� ?TC NT OF E =.LTH a.- . -._ _ ti .:..' _ •. .. r . e.. "y.._ " -..... --ca yi-� .. .ea -.. c -... v '• .. ..>, r ,r �. DIVISION OF E \VIRON,•C`TAL HEALTH SER%V10ES DESIGN DATA SHEET - SEPARATE SE.%.aG£: DISPOSAL SYSTE, FILE N0. Owner Ad i r e s sAf ZIA.. Located at (Street). � c ,„f . LCOw WO A p ._ Block .' Lot (Indicate nearest cross street) M nic:ip.ality o�y c; - v . Hatershed vj 174a 'SOIL. -PERCOLATION TEST -DATA REOUI,PED 'TO BE ' SUB"11 _TED !•?ITH APPLICATION' . ........ - 5 2 :2? 9.f Hole Number CLACK TIME PERCOUTIOY PERCOLATION Run Elaose Deg t-'- : to -�- ater G i7ater Level No: Time Frog:. Ground Sur-ce in Inches Soil Rate Start Stop Min. Start. Stop Drop in Min/in..drop Inches Inches Inches ff/ r 3 . ........ - 5 2 :2? 9.f 12 -.° .4 Notes: 1) Pests. to be repeated at sa ^e death .until approxi -_tely eoual '•soil rates are ob- tained a.t each.percolation.tesL.hole. All data to be submitted for revie,,a. • ..".> ..:. :a.r .K3-., ....wu-...r u ... y -. , _ " v. -r. ._, ec ._. ....: . :..... -,f --..r ..err -.. .., rw, .... .. -q.n� .. .. .. _, ... - i- TEST PIT DATA REQUIRED _0 EE SUBi•IITTED ::ITH APPLICATIO\ DESCRIPTION or SOILS E`'-^U`TERED I`: :"EST HOLES DEPTH HOLE N0. I. ,HOLE NO. �/ ROLE1 \0: t G.L. 6 �a Af Zz 12?, !fi✓D:. L Jr 2 4't 3 0" 3 6'T 42" 48" .Li 5 4's a .6 0" 4 661. 2., fit ME:? 4 19 71 Ck INDICATE LEVEL AT WHICH GROUND WATT R IS ENCOU \'� D?E H- AL W© INDICATE LEVEL TO Sv'HICI{ Lt ATE" F, LEVEL �I1 S AFTER BEING E \COONTERED, ell TESTS LODE BY...:: _ y- c. to �"3' 2� Soil. Rage Used Min /1'' Droo S. D. L'sa2le Urea Pro-. ided . _ A'o . of 5edroo7l.s Septic Task Cap =city a-� Gals . Zlype rem �.✓� Absorption Area Provided By ��.%L. F .Y 35,E '�. cltn trench. ;other Name ST1u�'�NLEY .Ja. LANDER Address BOX 267. ' 3:= 'ra s. a s PUTNAM COUNTY DEPARTMENT OF HEALT' ®� �y Soil Fate Approved Sq. Ft. /Gai. Checked,.bv Date T; i Ldcafiid at 6 4A�b.W, :Separate Sewerage ;sysfem: built by A. -7 ! * * Consisting of 1 -57- Gil Septic, -Tank 'Oth-, r riO e u Omen Water., Supply Public` Supply From . i` el _VI Private Supply Drilled B O Addresi. :J b Building- Type His.,Erosiori, Control. Been. Completed?, tl certi Y,that he pre i ' the systdm(s), is 111steo-serving ( ailIjitch -a �i n 4 ed' with 'the .staricl lub i��r8gula ions' attached] Date �I 4 to Address Any i, occupying' premises served 6 the above sy ' resulting from such -usage.,' Approval` of the separate .sew -available. and the,approval of Ihe pHvite'-Water supply shall lbec , , ­ change * ; � ' ' . of , 9MeJI! subject Ao' mbdificition or h- he�jUdgr�enI,-,the:-Cq VY ep,,. in t, Y. By a] Town or Village iSee Bloc Job Address Width trench ti r t Issued - J6 ai 'De Permi of t Bedrooms -M t work (copies of which are F e t I shown '0 on issue ne,p ans o Ahe comple ted W, (copies v 11 js . .­.; " by a. Ptitnoirn,'County Department of Health. -P .E. R A. i0tly,tiki may necessary to secure the correction of any unsanitary :age system .- shall h-echm , e '_ null and v . oid'as' soon,as ' a public'-.sanitary sewer becomes and "void water. supply 'becomes a,vaitatok Such approvals are imissi'oner,of Health suchrey 9 ri.'modlfocaflon :o'r-chan_Oe is necessary. '�%�+ . ''�Qi Tit 1 77777�7 '77 F PEEIT. MEDICAL ' LABORATORY 1879 Cra pi on 1Rd.-Maple Terrace Bldg. 1A flew f Qrk PE 7 -8777 �� ur LL 'Sr .� e�,,i�- -n��- G'�Of -�4- ���^r� ---z �cta�'• :-- ..`n -K„ '�a , "}." -�. ,.... -'� ,`,.., f..w x. "�:F;i. J �'', . rb',a t �5.� . ix _ DATE COLLECTED DATE RECEIVED t. V1i,t E. TOWN & .�k NAME OF SUPPLY DATE REPORTED B!~C _=' P.' P NiL. (Agar plate count at 350:.) j COLIFOI�NI GROUP (!�osfprobcblello.j100mIJ RESIDUAL CIiLORI1+tE A3 RECORDED AT 184S ')° 1 a SAMPLING POINT I POIN' OF TREATM C ttLO'II�I,S (('I) - mg.; 1. NITRAM (as- - Mg., 1, FLOUPIDE ;F) ing:.;I: These resulfs ;ndxala that the water was yr&a# a safislacfi;n� l #ciry gvc�It�y whin tT�e sample was c oilected. A. H. PAI;OVANI, M. T. (ASCPj in DRILI . "' I S LOG AND REPORT Y L> > Vel°1 at - ,S 041 1 n ('T k in ,r /;4� kA - � Coun Tl ty of � Y+ u Name of lace 1ty, age or o .,_.,.,_,...,,..., - �✓ t,t�y___ �,..._1 �l! ..L►zurr.+s�,' i. .:w > n. Depth of weli �_!.,c Dia -eter Yield `� �� V1as we 1 sIt ect ft a in, gpmo 07` 'hrto of casing above ground /_j Below ground ./,5 Well seal C �= :.Ery l I Gp p&ek;7,'7.d.emenE gr,4 7 a. -� A i(4m Draw a cell diagram in the:' provided below and show the 'depth of casing, the :ell seal, kind and thickness of formations penetrated; water " bearing formations, diameter of' drill , holes with dotted lines,,,' d . casing(s) vrith, solid IinesA a LL .DIACT? lrl[ FORNIlITIONS PENETRATED REPd M . { Dian -ter9 ixie Depth Kin ., thickness. and Type of well •7 in.ft1 if wate�,bearing Drilling method v GRI'� E� Was well dynamite �5 ` _PUMPING TESTS Details 77,77i 7.77:7 Static water -4r+ �. level, in ft, i ?: j ktiry, 50 j be ow grade i --T' is Pumping rate 1Y gapgn, 4. 75 , Pumping level in j d 4. f f t a below grade r� ..i __,_._ ..._ .... Duration. of 100 test,, in hrs. rys ,• - _ :... [!,TER ..AT :END OF' TEST kr CTeAr.Cloudy, Turbid W a 150 Recommended depth; = of pump .�n ,ysr swell, .feet b.el ,0,;,grade" [L? S IN SnND GRAVET 200, i Sand Effo size [ _. Unif. e. Coef o Length of screenr » r Diam, of screen 250 ; `type o -f scrQcn -- ' - , Screen openings x. IIf r { j COP;1II,NTS: yY e proporty aili the back of this sheet � Drilling st-,:rtedNc' ;` 71 Compl;eted__hcv' Tt,�:' ; locating the ell and sef.!age "3 dZSpo;T s;,�st r_;.�o i [[el.l Dri`llo,r Signature _ -�., �F ✓,C/^�.t ::r "l.' -iv. . �r.`.' s�?,!'�/,�r�'_.�'� °- .�'- �.... >. _ 'm.- ,. ... .v 'L',.�.%i�Y- .�'Y•y -'v -�r- ..- ,:��sai..�r'tr`7���. --�, �,�.yr'�'�.5:.. ' Owner or Purchaser of Building Municipality /109X AW --1'-7 Building Construe ed by Section Location -'Street Building Type Block Lot GUARANTY 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 guaranty to the owner, his succes- sors, 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 de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of as-to whether or not the _ ._. £k3 Ui -:vf -the. system t9 op -e2 atC was- cd'u5ea by the 'w111Fu1 Ur negl`ige t act of the occupant of the building utilizing the syste Dated this day of jo v E 19�� Signature C�t ✓ Title 11,®• &% KTn^"�-" If corporation, give name and 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. 1/4-1 Division of Environmental Health Services, Putnam County Department of Health ' PUTNAM COUNTY DEPARTMENT OF HEALTH DTVISIO 0 F N F. ENVIRONMEN�'A ,K SERVZES - r ' c.•_. aQ^ c..., rr...-- .:.�.- �- .i...w.... ' COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE Owner iy t, c, t �F.j _- Located at ( Street _(f4"V pe" Ind! c, ..Municipality:Ea,�) "p r, SEWAGE DISPOSAL SYSTEM FITS NO. Address ���� >�, {�di�,.:,<<�'� n a) KoA-V See. Block / tot nearest cross street) ' 1 �4 , Watershed aw,`'�, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 4 Hole j Number CLOCK TIME PERCOLATION PERCOLATION Elapse NpEh to Water' Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop. Min. Start Stop Drop in Min. /in drop Inches Inches Inches a 4 5 5 dotes: 1) Tests to be repeated at same depth until a roximately equal soil., rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 13 TEST PIT DATA REQUIRED TO BE SUBMITTED. WITH APPLICATION --..--.DE3C:R-1.PTJ.0,N- OY-SOIL.3- --l-M VD, T 0,:u 7*1 .�.T.F�,5T, q-Ti-QLF HOLE 'NO. P/ HOLE NOPI:�g ',,EPTH HOLE NO. A, 1 AJ 4 . t MICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED E LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERID ;STS .MADE BY DESIGN '12,'� Rate. Used—, Min/1"Drop: S. D. Usable Area Provided Bedrooms Septic Tank Capacit sorption Area Provided By ' C L.F.x2 J., STANhR( 4 i ANN 9 Le thi . vt"i ls, :ZPACE FOR USE BY HEALTH DEP 1,` Rate Approved Sq. Gals. Type 36" width trench. Othpr Ft/Gal. Chocked by Date 4 ' e` "LF TIV i L r �s n�' iu p willow, , a 41..iJ y. WIT V a' Mir- 4W 'rS p �"M1� 7 r 4+P R t�• a s r t� ) . 'gad l eta t'r j 4 ,} s i a T VIA t �. TF Iii 00, 44 \.; 1 SEA 1& 'v'WQTV 11.0 not i 1 C QU Of PRO ': U min 'p r' SEA 1& 'v'WQTV 11.0 not i 1 C QU Of '� � s ,zx LiyF � "' £ i y 3. "�� � ��� ���}�' � ��#"t..�r'• � '��,t�w ie�'t: '�"��t��r c'.`�:.- +— ^r�.�.•.r�. ' {fit pd' °• u�� Wft '���+ �u � r , w . off'. ,y ti s M ti '� � s ,zx LiyF � "' £ i y 3. "�� � ��� ���}�' � ��#"t..�r'• � '��,t�w ie�'t: '�"��t��r c'.`�:.- +— ^r�.�.•.r�. ' {fit pd' °• u�� Wft '���+ �u � r , w . off'. ,y ti s M