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HomeMy WebLinkAbout3229DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -13 BOX 26 IN. -.9 T. No ., IN ,6 � �, r . LZ , .. '. i - 03229 sy T;RCA-4 L_ -0F Located at 7- ! l PUTNAM COUNTY DEPARTMENT OF HEALTH 'Division of Environmental Health Services; Carmel, N: Y 10512 ` IEWAGtk'bI$POSAL SYSTEM i'owiVor - Vliiage— - Tax Map Block Owner - Separate Sewerage System built by Consisting of S& d Gal. Septic Tank and 1.1 ht E Other requirements , Water Supply: Public Supply From Private Supply Drilled By Lot Address /Cv(" Job- Q S. T'ip -E N c H Address }� Building Type JcrzAME YJ tee t N No, Pf Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were construc attached), and in accordance with the standards, rules and regulations, pla Date Address Certified by f as shown the plans of the completed work (copies of which are he permit ued by the Putnam County Department of Health. P,E. R.A. License No. Any person occupying premises served by the above system(s) shall promptiy take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such 'usage. Approval of the separate seweraggsystem 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 id when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Co ilsione of Health, such n, modification or change is necessary. Date By Title _5_;?5ar� PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM u/ Town or Village Located at �g RO" �� Section 1 Block Subdivision %L -c- s'� HI LC- f =!7ZaJV / Lot / Job Owner___- / .E1 N V,/ t:1' ��i 7 4'� 1 i-- C /,A i-F�� Address Building Type Lot Area 5 At�F Number of Bedrooms �E7L -kt Total Habitable Space Square Feet ji EisJ �i Separate Sewerage System to consist of � Gal. Septic Tank �© ` lineal feet X � � width trench To be constructed by A >� c � � � l Address fl^ 2A.a 4 / V Water Supply: Public Supply From —, Private Supply to be drilled by = % as Address Other Requirements �1- —7(� .�i �Z.�V4EL I 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 o e u nam 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 during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of tAe original syst m 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 insta d ccorda c i h the standards, rules and regula ions of the 'Putnam County Department of jHealth. //� Date / -� 1 Signed G P,E. R.A. Address •r � S - i� ��� EC%�] /o.f�%1 ��/� ! y License No, r °' - APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless 90111truction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the ommissi Ith. Any change or alteration ofction requires a new permit. Approved for disposal of domestic sap** age, iva er s ly. G PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - '�COUNTY OFFICE BUILDING, CARMEL, N. Y. 105 5 12y DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM ,,.`` ..-FILE NO. Owner'Erkt4 QVA6 , Address T%at�k*'A' �1 �'�► . Located at (Street 4LCH.04 Sec. Block Lot �"Indicate nearest cross street) Muni cipality ?%xtti3 94'r'% .Q LO. Watershed ?t9V4 .%X(A1Not. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Dep o a er Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 13.:M 1:4 -i VL Z (4 2 V. V? -t;.", ) I I 0 'l Z c. 3 z`.3g Z: 1 Z.i Z4� 3 S 4 V.SC 3'.00 ?A 5 V Q10 - .' A-L 12 21 L.3 Z ZI Z3 Z 7.9 1 3 10•.14 10'.15 ki 7.10 'L .. L $. 4 LS 10 '. 3� i '2. 2'a• Z�1r Z tc 1 10�•4� 11'.44. IS ZI Z3 Z 7.9 3 4 5 Notes: 1) 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 SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. 6" 12" 18" 24" 30" 36" 42" 48" 54" 6o" 72" 781, 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER WEL RISES AFTER BEING ENCOUNTERED - TESTS MADE BY �'•��wS��tke�'� �. Date ... -DE IGN Soil Rate Used (+ Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 4° Septic Tank Capacity l00 .Gals. Type tA Absorption Area Pro ded By 4 ".L.F.x24" 6"— width trench. ether name , wr %. w iQijw - 5ignature f Address n %=41w SEAL ' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date ,r PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1. i rq Peekskill, New York 10566 DATE COLLECTED RESULTS OF EXAMINATION OF WATER (? 1,7- 76 OWNER DATE RECEIVED CITY, VILL.�!.,iGE, TOWN`VOR NAML OF SUPPLY DATE REPORTED Lo' 0 #t SAMPLING POINT CC- v PE 7 -8777 BACTERI AZR ML. (Agar plate count at 35 C). COLI ORM GROUP (Most probable N6. /100ml.) HARDNESS, TOTAL - PPm DETERGENT) -pp. NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (t;) - mg. /1. These resultindicate that the water was U� of a satisfactory sanitary quality when the sample was collected. l ell,— A. H. PADOVANI, M. T. (ASCP) i1 �A S . er c,.¢-• t+•• -..c. v, :.s .�+_.... ..:.:q,.ti =• r� r - , .. _ .T: .- c.._.....v,'..+,. �.��cs �;-.c- o•.:.o. w :o �_. .. d:. -.- _ .. - � _. .`}.� �. _ .. �,.-z...._e� .:a'. Owned Purc aser o ui d ng i- ding Constr c by Location - Street Building Type Municipality Section Block Lot GUARANTY OF SEPARATE SEWAG E- SYSTEM LLV represent that(* W wholly and completely responsible for the bmajIMM, workmanship, material, construction amMmjuMjaMW 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 (JS 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.tC 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 Health as to whether or not t failure of the system to operate was caused by the willful or ne lige t act of the occupant of le 4bilding utilizin he sys�A Dated this day o 19� Signa C , Title cZ�� tl%—_crp-o ration, g and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE, CERTIFICATE OF COMP%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 'i 'T i LA� .•t Q GLl- c ``� NO TRUCKS, MACHINERY, BUILDING MATERIALS NOR EXCAVATED EARTH SHALL BE ALLOWED IN 'THE SEWAGE DISPOSAL AREA. CONSTRUCTION OF THE SYSTEM IS TO BE IN ACCORDANCE WrTH THESE PLANS ANY REVISIONS 'THERETO AND THE RULES AND REGULATIONS OF THE PERMIT ISSUING GOVERNMENTAL AGENCY, j, 11 APPMEID S AUG 19� 01- -a �\.y�ilin2. '" .Y � p S WERAGE DISPOSAL SYSTEM. m NAME * STREET � 4?i83 TOWN4"'Lj7lnf • =mot Y;..:• COUNTY ,PUT-46, NEW YORE• NAL EILG0 LOT NO. 1 -' BLOCK TAX MAP NO. SUBDIVISION a; =..W C)S4 -) CONTRACTOR 1�> =- PROPOSED PLAN: 3R '"1bEH• a+�'Th•_1L °�"g•Ner n 8N3iN$EN8 �.i CONSUL 7)N(; .N £NGII AS BUILT PLAN: APPMEID S AUG 19� 01- -a �\.y�ilin2. '" .Y � p S WERAGE DISPOSAL SYSTEM. m NAME * STREET � 4?i83 TOWN4"'Lj7lnf • =mot Y;..:• COUNTY ,PUT-46, NEW YORE• NAL EILG0 LOT NO. 1 -' BLOCK TAX MAP NO. SUBDIVISION a; =..W C)S4 -) CONTRACTOR 1�> =- PROPOSED PLAN: 3R '"1bEH• a+�'Th•_1L °�"g•Ner n 8N3iN$EN8 �.i CONSUL 7)N(; .N £NGII AS BUILT PLAN: , -, - * , , .- .- ': � . � . ,vl � � � � __ , . I - � I- , , � ... --`� - .-,!; - , ., �', . !�� � � , "I C." � '.. � -�; ��.',,, , , ",", ­1 - t- ; , , �,_ . � . I , . 4: . � � ". - -, ", -,,-. " .-, I .,.­,-.,�.-,' � � . 0 .;*, - , � _�_ " �l I ,� -_ . '.�'r ,� .`.', 7,��: 11 - : . .. . , - , : , , , , I . . 1� 1. * - , . . �' m . � .. ' ' , : ,..f � . � i , . k 11 )"