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HomeMy WebLinkAbout2942DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.17 -1 -4 BOX 25 02942 �r0 J6 ! E PUTNAM COUNTY DEPARTMENT OF HEALTH J Ni Division of Environmental Health Services, Carmel, N. Y. 10512 E CERTIFICATEOF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Vil e Tax Map Block `S Located at �r Lot JQ Owner Separate Sewerage System //built by Address low op Consisting of/ Septic Tank and Other requirements Water Supply: Public Supply From _2 Private Supply Drilled By Addr Building Type No, of Bedrooms -- Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essenti aslshown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans III , a tie permit issue by t e Putnam County Depart�me/nt /_of_'Health. Date Certified b w P.E. " R.A. License N Address Any person occupying premises served by the above system(s) shall promptly take such action as may be necerry to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Com issio of Health such r cat modification or change is necessary. ° ` Date By ..a �" 9 �1 Title —I CONSTRUCTION - PERMIT ' FOR Located at wwi Subdivision Owneryll/�� Building Type _L of Number of Bedrooms PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. J. 10512 �f S WAGE' DISPOSAL SYSTEM / Town or viii a Section Block Lot Area t/ a Separate Sewerage Systeyt2 consist of Gal. Septic Tank To be constructed by rm� Water Supply: Public Supply From Private Supply to be drilled by Other Requirements Lot Job Address Total Habitable Space Square Feet v lineal feet X width trench Address - - -, 1 represent that 1 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 or 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 or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system du 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 nai system or an repairs th to; 2)`that the drilled well described above will be located as shown on the approved plan and that said well will be instal n accordan the sta s, rules and regu ads of the Putnam County epartment of Health. Date Signs P.E. R.A. Address ' License No. APPROVED FOR CONSTRUCTION: ThZs. approval expires one year from the date issued unless con r ction of the building has been undertaken and is revocable for cause or -may be. amended or modified when considered necessary by the Commi er Health. Any change or alteration of construction requires a new permit. Approved for di of domestic i a wage a r privet r- supper on y.. Date -,�`°' BY ^�� Titlet� V .w .37 t - W- 'I. PSIL, ATOR, K M d '34rC n A;- Apt ` V, . 1- v , A P1�777, P60 kill,? f `4, FLOURIDE (F) - mg-il '-`F�`-EXAM DATE OLLE -W CTED�,�,,: OF.: IN." F�l -'RESULt��- A 0 P"J ti A C' ER DATE f EIVED 0 The d- results indicate "l, N AM:OF:SUPPL Y� CITY VILLAGE 'TOWN'VOW t. - DATE REP ORTED g R' .'Wt f: Ck 6 4 SAM PLING POINT,tp A 04 J '! 35? -COLIF � P W6� 0.. Q. BACTERIA PER MLI. (A40r'plate count .at 00 RDNESS, TOTAL n pp' ai 4 DETERGENTS-p pm � s,N) p m n. tON,4TOTAL - PPM . ..... . FLOURIDE (F) - mg-il j, P"J ti A The d- results indicate that t di, 4 4 7 x mu iE L -k MAl M pi j, A Z" At" H PADOVANI; M.: T.'(ASCP),, 4. di, j, Gallty Vvhen the ,sample was 'CP116iAi;d. At" H PADOVANI; M.: T.'(ASCP),, 4. 7 x mu Owner or urc aser of Building Municipality Building Constructed by Location - Str et ti s L ,� ,� Bui d ng Type Section 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 . . . G:e s:. of. the....Putnam...Gounty... Departim'en�t- o. f- -He�alth-� a s -• to-"who thiep' o'P _ .. failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this l2._ day of 191e Signatur T i t 1 eke '�, ��� ., >-� 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. Division of Environmental Health Services, Putnam County Department of Health Y WELL 1DOCATIONL&-cet t. 1 street section bbock `.ot .{ r, r 1 6� �.Y d�iJi� ho Y '0 r name address city ;.to�nln .® .ill I ilk tip, � WELL DRILLIM lL&C., • I, Y.,i 1p'n, wth e address cite ,off towns ASI DYTT A I US YIELD TEST MATER LEVEL SCR ;ENS, D S :" . ``; <:li , ,,,,i: Bailed Measure i:rom land-surface) iengho '� 5 .. feet or PumpedAH o Static Makeo `., eft '4 .�- : en B il�e - t : .. a Dtameter o Pum ed- Te . '. . .gt Inhes °GPM ° , . :l2.,�oe eKinde D iam. te:r ' ' , DTAL DEPTH -OF DELI; � � Feet ". y Depth From Give description of formation penetrated, such .ass peat,. Ground Surface. .. °- silt, sand, gravel, clap, hardpan,, shale, ieandston ®'9. anite, etc. Include size of gravel diameter aad $a�ad fine, medium, course) , - color of materiaA, : strtac,tta e; :' Loose', packed,. cemented., Boft, -_.Oft - ..hard).o:(Exo: fine , packed. Lei low - �:to..:13 ft =fir �y���? ite1 _ ..9 - s.ai .d.q... X2,7 ;�f t -a, .. �iA case i .Feet Formation- -De scri tioh - -Sk(!tch. exact.., location ,of�+:tP` ®l ' to 4 at least •two ermenant Lan -- � .7 Po L` 1 2Q C)__ Bliwe_ 1 5 .BFI dIt!i • V ,y i {1 )ate Well Completed ,S— Date of Repo Well Driller tat �,�i'�rf" -,r - s � '�;�`= `t' ~. ` : , ��, `x"'+ y ^ Via'. �`t�£'�1,t:'� ttf.•� , ,��' �.; µfl i! /T,F�'v'� .. ,�lJ r, % ; ,•',` : '.`- 1y . �.r,. ..rr i ..t�ttH � ie�J`M... n'•k� F" � ti' � �,4y �: ' '• Y}� x ti+-�4 a,,,,: 4x,��''°a All OVE Tp�Y 3 w. >"^t '�tti�ry Y K} ?av -t., da x L ��� �` �� m � .! Yii. Y" �L7. • e ,/�'q �j s rte, t� •4, t r +.'�S _ '+. r •K.y a. `� ".� t^ 5 � � � � f � i � } s 4 Y y .0 � Fy ia.�. l ' •�`y. •w•+?{r, .M`aw. +`wb .wv s'S. aerif, eea�mar -.r.y w�. f Y ` ! 'V tt ! i.t-Wf -197 --- S _ !111711 WUN U HEAL b p i �. IDIRE OR, afV1. ON 0 . p1h '�5 OF• NP�v Y. a 640 70 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIO;ti OF ENVIRONMENTAL.HEALTN SERVICES Date ✓a2 . Re: Property of Located at IL & Section Block Lot Z-^ Gentlemen: This letter is to authorize George,A. Haughney a duly licensed professional engineer X 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 Vl111CL L ! Vl! w i fl i.iti5 ►►►a i i er a;lu to. 5upez-vise ine construc ciun of said system or systems in conformity with the provisions of Article 145 or - 147,au�dti�r�=aw, •the.:t,lc Health. Law, and the Putnam County Sani- taryCode. - ....._ ... .. . _ .__. -::._ . ___ ..__ ._._:._._ _ ...._......_ ...:._ ......._..._... __ Countersigned: RHtt'j' �. -, OF N;:. P.E., R.A.9 # ©I Route 52 Address 'y�y Carmel, New York (914) 225-9353 ,` Telephone �= W 1. mac, SIVN � 411 51142 Very truly.yours, Signed -�1� - - -- — Owner of Property Address eeA--,,eAJ 1j `'z6 6��c� Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING CAFS4EL ,N.. Y. _10512_., DESIGN DATA SHEET- SEPARATE SaWAGE DISPOSAL SYSTEM FILE NO. Owner &g2ze. Z6V4 Addr ss e Located at (Street Sec. Block Lot 4n ica ' nears cross street) Municipality / Watershed SOIL PERCOLATION TEST DA REQUIRED TO BE SUBMITTED 19TH APPLICATIONS Hole, Numbr CLOCK TINS PERCOLATION. PERCOLATION film apse Depth to ater 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 i 4' 5 • 1 •� 2 3 4 5 Notes: 1) Tests to be repeated at same depth until appproximatelyy equal soil . rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be mzade from top of hole. o 5•'3 i 4' 5 • 1 •� 2 3 4 5 Notes: 1) Tests to be repeated at same depth until appproximatelyy equal soil . rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be mzade from top of hole. DEPTH G.L. 611 1211 1811 2411 3011 36" 4211 48" 54" 6011 TEST PIT DATA R QUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS jET1COUT!TJ,1T,ED IN TEST HOLES HOLE N0._1 HOLE, NO. HOLE NO. 66" 72 '5 P1 78 84 INDICATE, LEVEL AT V=,CH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO 1' 11 WEER LEVEL RISES AFTER BEING ENCOUNTERED TESTS` MbE BY 7 Date op,: D.- S.D. Usable AreaTProvided No. of Bedrooms Septic Tank Capacity O Gals. Type Absorption Area Provided ByJEC) L.F.x2411 36' X` width trench. nt daA449C-) A�2� /,2�&v 70 F N, K714 Address NO= SEAL THIS SPACE FOR USE BY HEAVYR DEPARTPf_E1fT ONLY: Soil Rate Approved. Sq, Fit/Cal. Chocked by_ r-n LLJ LLJ PE FES