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Home My WebLink About2797DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -2 -20 BOX 24 r 02797 �Q PUTNAM COUNTY DEPARTMENT OF HEALTH eer Provide Permit q 3186 Division of Environmental Health Services. Carmel, N.Y. 10512 mg>n ' on CERTIFICATE OF COMP CE Permit q LIAN�� ,CONSTRUCTION PERMiT FOR SEWAGE DISPOSAL SYSTEM Located at Aht oiP_ f /GG j? 4,1,0 Town or . Village Sa'odivlsi(pd Plnine DO 'S.11 '. =i iJ Yi: _ Subd. Lot q �3 Tax P - . • .... - . ... . Block v L Lot _ Owner /Applicant Date of Previous Approval Town A-' 29-4 .t9lJL L�irr, y am_: Building Type a Lot Area F FiB Section Only Dept olame Number of Bedrooms Design Flow G /P /D PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of Gallon Septic Tank and �iL' ! 1 A @'� G To be constructed by To& :( c•L7 dY- !''!-Pd Addres9 Water Supply; Pdbllc Supply From tt { Address or : _Private Supply Drilled byM .P4d W01-- rAtJAM s Other Requirements represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs of assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the origin system or 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 ordance with the ndards, rules and regu aeons of the Putnam County Deparrttmeept of.-Health. 1 Date -��J / d Signed P.E. R.A. [, r Address A�� License No APPROVED FOR C STRUCT T is approval expires one year from the ate i d unles onstruction of the wilding has been undertaken and is revocable for cause r may be r modified when considered necessary t Commiss' er f Hea Any change or alt tion of con rructtiionn requires a ne r pr v f disposal of domestic sanitary sewag , ri r private to p y n gJy') C• v Date By ills d1 !A`�O PUTNAM COUNTY DEPARTMENT OF HEALTH r. r DIVISION OF ENVIRONMENTAL•HEALTH SERVICES COUNTY OFFICE. BUILDING, CARMEL, N.. Y. 10512 ESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE Owner r!-, #,7 //4 � are IV /NO•. Addre s s�0 2 pt -1 ;1'�c ;�/ % Located at ( Street Tnke, Sec: Block Lot k.'indica e nearest cross street) Municipality &4h,om Watershed APE SOIL PERCOLATION.TEST Al REQUIRED TO BE SUBMITTED WITH APPLICATIONS /DA • o e Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse, Depth to Water Water Le ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 / 1- / 1 / q . oZ * a2° S1 ote 3,� Dom, 3 .� �t.. 2 7 3 /O 5 -2 3- 43 3 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. 4 - Ir 8'4" �r _ MICATB LEVEL AT WHICH CMC= WAM IS i ENCOUNTERM �MO W- MMICATE LEVEL FOR WHICH WATT L'iTFL RISES AFTER BEING EN N O V Or TESTS MADE BY D'#42 d a •r N �' DATE ,Q . DESIGI Soil Rate Used I� Min/1" Drop: S.D. Usable Area Provided TO j9 No. of Bedrooms `T" Septic 'rank Capacity 1 � ,�� Gals. Masonry_ Metal Absorption Area Provided by424L-!L.F.a 24 "_ 3b" width tr`.Other Name _7 a / e .37) d A u f► i � Signature � Addres' i d P.P Rj- SE1iL ILIA A/ `'I PU j'g,¢pl County Health Department So::1 Rate Approved Sq.Ft. /Gal. Checked by Date ,1( ,•: TMT PIT DATA =U= TO BE SUBM D W APPLICATION , DESCRIPTION OF SOILS 'ENCOII0MM N TFST ROLES. HOLE NO.� HOLE DEPTH HOLE N0. NO. HOLE NO. 61• 12" so / 24" �_T M 1 • 36" 42" ` 48 " 54" 60" .. 66" 72" 78" 8'4" �r _ MICATB LEVEL AT WHICH CMC= WAM IS i ENCOUNTERM �MO W- MMICATE LEVEL FOR WHICH WATT L'iTFL RISES AFTER BEING EN N O V Or TESTS MADE BY D'#42 d a •r N �' DATE ,Q . DESIGI Soil Rate Used I� Min/1" Drop: S.D. Usable Area Provided TO j9 No. of Bedrooms `T" Septic 'rank Capacity 1 � ,�� Gals. Masonry_ Metal Absorption Area Provided by424L-!L.F.a 24 "_ 3b" width tr`.Other Name _7 a / e .37) d A u f► i � Signature � Addres' i d P.P Rj- SE1iL ILIA A/ `'I PU j'g,¢pl County Health Department So::1 Rate Approved Sq.Ft. /Gal. Checked by Date ,1( ,•: 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date�J Re:- Property of 410.1 Located at �1��;J� Raz Rb, D (T) P�ft6K Section Block. Lot: Subdivision of -4 ah wi�s�icj�J}a Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize ga j e/ Am ayq-e- a duly lic.ensed 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 y. 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, Signe d C Owner of �Pro pty Countersigned: / � P.E., R.A., # A d�r ss � Address Town Telephone Telephone 0 0 .... DIN. RM. rKITCHEN MORNING RM. . . ".�HE.N IOAX1219 I1IxI20 LIV. RN 18QXI2u Ist Floor FOYER 91X91 1303 P�l BR 2 I:r I 151.1219 C) 2nd Floor A Q1 E--4 - f ) r"I ti FAM. RM. 1611 x 1219 WAKEFIELD 27'x.48' L--J U * --) BATH -2 . . 0 00. > BR d4 B4THPI ... WALK-114 CLOSET A.� Z OPEN M BRs I BELOW 161 x 161 STUDY 12 L x 5 9 t' PENN LYON HOMES INC. Old Trail Road, Selinsgrove Pa. 17870 Telephone (717) 743-0111 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMERM HEALTH SERVICE'S INDIVIDUAL WATER SUPPLY & SUBSURFACE SZOM DISPOSAL SYSTEMS REVIEW -SHEET CONSTRUCTION ... . , .., .. .... � -- . RPERMZ T BY: (Name of Owner) (Street Location) _ COLTS YES NO DOCUMRUS 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 r 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 ars.ior� Area °shown•gra ity. flow ,�� - _ -- ___.._. _ -- -- _ - -• -- __ -• . _..-. .�... �- �-- - -. -_- 1f ° "Pumped`Pit "' & - -D Box Shown & Detailed...T�_ 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' from 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) :I I Data On DDS Plans & Permit Same