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HomeMy WebLinkAbout3205DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.19 -1 -20 BOX 26 03205 . . .. .. �. go I kmi I ,. - �r 03205 9 1 Lk, PUTNAM COUNTY DEPARTMENT OF HEALTH :. e r . D/V/S!O/1 ofy ftm ronmengl Health_ Services Carme% N. Y 10512 �IEtRT1F.id:A9fF OF COWSTRUCTIgN;DQMPL- tAN,G�9 F0 R °SELVAGE DISPOSAL: SYSTEM �ict%n) �� Uin C.C. � a._.s.. .+...„x �3 � A wr^•v +����^ �r'"� y- R�'�°" '`..�,.�.. '�",..,.:'^s.�..�.."�'."^!"{ .c. .c"^T� `�OWn Of �/ Ila�e ..— �S °P^T�u� -.}.v Located at PIA O � a �� � Tax 'Map Block Owner `t Job' )Th)AN'1£ii"�•5 G Address /�14 C�Pf1 C • %V �/. Separate Sewerage 'System :built by T— Consisting ofd Gal. Septic Tank and:% `'�" Other,'. regwremen ts - 3 t r Water SupPIY bhc Supply FromZ �� Private Supply Drilled ,By 1 x 1 Bu�ldin9 TYPe�5 p`� No } -of Bedrooms Date Permit Issued K ' = Has, Erosion Control Been' Compl,eted� " "? t' ertify that thesystem(s)_as hstedserv�ng the ab a v�re ~essenU ly as shown on the plans of a completed work (copies of =which are attached); and in. accordance wdh `fhe standard" regulate led d the permit is d b th utnam County Department :of Health R A t Date " ' .it � 'bY _. , _.• P E t , Address 1� ' License No 1' "19 ats t� Any person occupying premises served by the ve'_ ' tly V e such action_as may be necessa ►y to °secure the correction of any unsanitary :conditions-'5r, esulting from `such ;usage `Appro4 o� araf stemsnall become null`and void 5s soon as a public sanita►y sewer becomes _available and -the approvals: of the ,pri waters : mOwner or Turbtiaser obi ding Municipality Pj l-ies = c' `77 Building Constructed by 7-A-:*- MA-P rte... q?,t9.4 r_> -' Location - Street Block Building Type 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- vic _.,,Qfth.._,Pu.tnam . County Department of , Heal -tai .mss; -t o- hethex�.�:r:.:no.:th_e _. f ut � of t''ci sy st;e -gin °to "'op-era'uo i a's "c iis�cT "' y t ie"wi1 ul-or "negligent ~� act of the occupant of the building utilizing the system. Dated this V day of P a✓ 1,9 6 40M_e�.s ;E�C, Aos7hj- >AD Signature Title If corporation, give name and address) P tj_y_ THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1,ETION 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 PUTI`UIM COUN`T'Y DEPARTMLPIT OF }1r-ALTII DIVISION OF ENVfRO1'NMEPTITAL }I -UJIi SERVICES COUNTY OFFICE BUILDING, CARPIEL, N.. Y. 10.512 DESIGN DATA SIUE T-- SEPARATE, SEWAGE DISPOSAL SYSTEM FILE NO. 2k, Owner jr04� Q 'F Address_ -71P -6xv -to 100 �:�y_�� . Located at ( street)S c, -. cr GA �YCo� 9 sec. r - Block Lot .Z3 n ica e near.-oss s reef Munj cipality P,.� -t j i� y fir\ 4� Watershed P 15 t TION TEST DATA R-EOUIRED TO BE SUBMITTED WITH APPLICATIONS hole' Number CLOCK TIbm PERCO-1-ATION PERCOLATION Run apse -p, to tva er water Levei No. Time nom Ground Surface in Iriches Soil Rate. Start -Stop Min. Start Stop Drop in Min. /in drop 1 Inches Inches Inches 2. j!� .. 1. _... 5 2-a► - 2 1D S�, lfi , �� li % Lo' 4 5 . 2 3 5 -Notes :. l) Tests to be repeated at same depth until approximately 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.. TEST PIT DATA REQUIRED TO BE SUBMITTIM 1•1I:TH APPLICATION DESCRIPTION OF SO= Ej- ,'CCUN'j.T,RI D II`I TEST MOLES DEPTH HOLE NO. HOLE, NO. HOLE NO. G..L. r 6 12" ... 24" .o N d 30" 36" 42" x+81 54" .60". ��1C� S. -.6611 72" Ste, Sa6 N &S . 8" INTICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEI EL TO WHICH WATER LEVEL RISES {��iA,FTER BEING ENCOUNTERED TESTS I�1A.DE- BY V���E �hN de _qe�vcJ�b�JF` Dote DESIGN Soil Rate Used 7-0 Min/1 "Drop: S.D. Usable.Area Provided So�� No. of Bedrooms Septic Tank Capacity b Gals Type j!1�,5 Absorption Area Provided By` L o L.F.x24" 3F- trench. er 7K Address e Q; .. SE j �,� �F NI'V I 1r THIS SPACE FOR USE BY FEALIPH DEPARTM 1N T ONL'Y: Soil Rate Approved Sq. Ft /Cal. Chocked.' -� Date. ...._ _ _...._ .._ __..... . . . ...... .. .. .. -._.. -° _. -.. _ - . _ -,. v - _ -: - _ :.. _ ..... _ _ ..:.•.mil..,.. ": -_._. - ..._ .. -. . _. -. _ - .� -_ 4 -PUTNAW COUNT; Division Of fnlarormen. CONSTRUCTION, PERMITr FQR SEWAGE ;DISPOSAL. S` Owner f7O14!i'fi/�f4° t�A! CA Building T.yPel�c� tiif /f} L. Lot Area Number of Bedrooms Design Flow separate "Sewerage- System';to consist of To be constructed'" Water Supply Publi c Supply From vale Supply to, be diilled by, Other Regwrements uy W _ / �of,,fhe proposed aystem(sp' i)�that` =•,Elie separate sewage_dispo al isystem Town or, Villag e7 - - -- Lot J- Address Total Habitable Space d� Square Feet I Septic Tank; and , ���;`.� /�/•./�f -� �� ��/(d4C ^`7/ Address����'� a r �of,,fhe proposed aystem(sp' i)�that` =•,Elie separate sewage_dispo al isystem PUTNAM cor,\­_ry J)r;iimo',M-N'r or HFAulf 'ALT11 SERV'rCrS DTVTSTnN OP. F.NvrRo,-,':•:FNTAT, IT % -- V& 7c;, a C-0 VJ6� Date A Re: % Property of A' \X 444 W ___jkQ ml Located at Section Vlt-4�CJt- Block Lot ;!P7 Gentlemen: �x H.*.p T/ ILEY I. - This letter is to authorize STAM LANDER i*duly licensed professional engineer or registered architect C2 (Indicate) to apply for a Consttuction 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,flealth, and to sign all necessary papers on my behalf in connection with this matter and to supervise the 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- Very truly yours, Signed of Property Count sianed: Address P.E*., . Rte, J ss . BOX 267 AMAWALM", - W. Y.* 10501 e ca u casw u iKN4 Telephone IV,- ep was 1 horie 0 PUTNAM COUNTY DEPARTMENT OF HEALTH- DIVISWN OF- .ENVIRONMENTA j3F_jTH..S R..VT1QZS.._ .COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner4rH,))e,4 J._�I#gRolv RclvclV Address. -!5-17 - i TAr- jlkp, VE Located at (Street 7-7 Block Lot =n 1ca7e nearest c ss s5e�t) Municipality. ,,Zfw,,-' Watershed J11OR 0 C/;r- /ge SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches //vZ 11,2 z 7 c4, —2— S 3 2 1122 /9 21 -3 5 2 45 3 11:37 22- 4 5 2 3 4 5 Notes: rates for 1) Tuts to be repeated at same depth until a Poximatel� are obtained at each percolation test hole. Affdata to review. 2) Depth measurements to be made from top of hole. equal soil e submitted TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE IV0 .. .�.%.. HOLE 1V0*. VH�LE NO �VF. G.L. /o PS.7JGpsv� 6"a 1211 18" c� a 24" 61—uele. 3011 =i 3611 42" 4811 5411 H JAW d Lz,E'.g cry L N H N 6011 6611 " 7211 h 7811 K 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED i�- -• I.NDIC.ATE LEVEL T0- WHICu .WA_TER� -LEVEL RISES AFTER BFI? ?r. ENCOUNTERED,. '1t�S`T'S} 1�1A11E BY. .. , DE IGN i Soil Rate Used�Min/l "Drop: S.D. Usable Area Provided Sr/ No. of Bedrooms 3 Septic Tank Capacity ��'D Gals. Type ''ic�cl& -r �Ve_- Absorption Area Provided By_L.F. x24" width rent . • r1.•r �i� P ������'.� i Other . 6 va z �w�,. v ., Name• °t�Signature U Address Alt' r Y_ 105 �ff L. 245-2645 &i® THIS SPACE FOR USE BY HEALTH DEPARTP v� Soil Rake Approved Sq. Ft Date i' .:, ,. :. -�:r �. r. __:.�:� r