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HomeMy WebLinkAbout3234DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -20 BOX 26 03234 yr.,. T EEL TL 16 6 . 03234 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �o A Town or Village i Located at 612. &-S,, L'�/y� /j Section Block Lo:.... .TAN 0 Owner i✓ OD a d-0CFAJ iN c Address CIeir'ct -I.W r .G141✓E r; Building Type d4ef • Lot Area Number of Bedrooms Total Habitable Space �° OO Square Feet' - - ":i Separate Sewerage System to consist of /10 C+ Gal. Septic Tank 9-� lineal feet X width trench'.`~! To be constructed by �'1 -�4f ��" Address r i Water Supply: Public Supply From Private Supply to be drilled by �✓_.G%Na Cif y� -( Add[rreess� Other Requirements I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal .systems above described will be constructed as shown on the approved amendment there to and in accordance with the standards,,rules an regu a ons of e u County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of HeaIthwill be submitted to the Department, and a written guarantee will'be furnished the owner, his successors, heirs or assigns by the builder, that said buildeI; 111`'M place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of t I ante of the approval of the Certificate of Construction Compliance of th original system ny repairs thereto; 2) `that the drilled well described above',;;i will be located as shown on the approved plan and that said well will be Installef in ordance w the standards, rules and regu a rTf ons of the 'Putnam r County Department of Health. Date Signed P.E. R.A. { Address License No. APPROVED FOR CONSTRUCTEON: This.approval expires one year from the date issued unless ruction of the building has been undertaken and is :T y revocable for .cause or may be amended or modified when considered ne essary by a Commis ' n of Health. Any change or alteration of construction `.,{ requires a new permit. Approved for disposal of domesti I ew ? / �j P privat only. , Date / � / „� By �/Vva- Title° .• `. 1;1: -- - -- — - n 3, PUTNAM COUNTY DEPARTMENT OF .HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR 'SEWAGE DISPOSAL SYSTEM 'Tj/- OF' Pu;jyAM Town or Village R Located at C 5cFnJr LA �Ve Section Block r _= Owner 5T `A N w coo 13 LP f t- D !'� Q 5 Lot � 9 ' Job Separate Sewerage System built by `�S .A. SC Pr /C 5 Address Consisting of 12- 0 0 Gal. Septic Tank lineal Feet X 3 6 width trench: r Other requirements r V (J N (c Water Supply: / Public Supply From %O Private Supply Drilled By Address Building Type �/VL' /Lv. Rc 5 . No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? P��O� yOR� A. Kf I certify that the system(s) as listed serving the above premises were constructed esse II attached), and in accordance with the standards, rules and regulations, plans filed d Date __ Certified by Address 2-23 ATD MA M Vt. Any person occupying premises served by the above system(s) shall promptly take such conditions resulting from such usage. Approval of the separate sewerage system shall Q available and the approval of the private water supply shall b$cor»e-rrRll'a71t1 �oid�0�jen subject to modification or change when, in the judgment of-the Commissioner o!,Aeelth, such C° _ r Date %f a completed work (copies of which, are -- he utnam County Department of HeS)th:' ;. P.E. License No. 2_ t to secure the correction of any unsanitary as soon as a public sanitary sewer becomes becomes available. Such approvals';rar,= mod. }cation or change is necessary Title k` IACTrRI A PER ME': (Agar plate count at 359 C). COLIFORM GROUP (Most , r probable No.L/j00rhli),, HARDN TOTAL lETERGENTS;m,7bpft0, NITRATES (as N) pool, IRON, TOTAL - ppm m V PUTNAM COUNTY DEPARTMENT OF HEALTH �...:s�.::,��.�_...�. -;;:,� �:; �-:r.::��. � '�. ��F�.B�'�3R��- '� -A•2� �"�FE�ES° ; COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. .= Owner 'y[AAJcyv e '91- Df :,-V C . Addre's s Located at (Street) Li4!✓, ,Seca Block ,' Loti •' (Indicate neares cross street) Municipality. Pv rN A wi kA ec & Y Watershed SOIL PERCOLATION TEST DATA REQUIRED:TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION I . PERCOLATION Run Elapse No. Time Start -Stop Min. Depth to a From Ground Start Inches er Surface Stop Inches water LeveI in Inches Drop in Inches Soil Rate Min. /in drop 1 lO '•� ��o .�) i 1 t0 �`B '' 2 to S j l \ •.�� i4� \ 71� Z 4 tk .ZC) l l - --scs \0 ?_)o z:z_l 5 3 .....� ...w. ..TR.csr�•__. 1_ �.� �:� v �'1..� .... e�� . _ ;� .... ..... �. .v..�� • ^K � �. �w s.�v�s .� -� � .w h+ .. ... ♦ t �.. .. W 4 t. Z.,(4 r `AJ-,i i5-:::, � _Z1,7_1 9 1 2 Z_;- `� z✓ i 7i% Z� Z Z 4 Notes: 1) Te'�ts to be repeated at same depth until approximately equal.soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 1811 2411 3011 3611 42" 4811 5411 6011 66" 7211 7811 . � 8411 _­INDICATE LEVEL AT, WHICH GROUND WATER IS ENCOUNTERED AFTER BEING ENC'OUNTE �E TO -.WHICH WATER " LEVEL -D *,TESTS MADE BYINI�6� Date St IGN Soil Rate Used Min/1"Drop; S. D. Usable Area -Provided— '&_&AQZ No. of Bedrooms eptic Tank Capacity Absorption Area f — By wi-dtb`;-" ch. Provided THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate. Approved Sq. Ft/Gal. Checked by kh A, Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION .,,,­-DESCRIPTION -OF 71,11GODY UIP -TEST HOLES,... SOILS.. TX -M. DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 611 1211 1811 2411 3011 3611 42" 4811 5411 6011 66" 7211 7811 . � 8411 _­INDICATE LEVEL AT, WHICH GROUND WATER IS ENCOUNTERED AFTER BEING ENC'OUNTE �E TO -.WHICH WATER " LEVEL -D *,TESTS MADE BYINI�6� Date St IGN Soil Rate Used Min/1"Drop; S. D. Usable Area -Provided— '&_&AQZ No. of Bedrooms eptic Tank Capacity Absorption Area f — By wi-dtb`;-" ch. Provided THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate. Approved Sq. Ft/Gal. Checked by kh A, Date Owner or Purchaser of Buildin Municipality Building Constructed by Section 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- vices of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of he building utilizing the vstem. Dated this day o 19 .Signa.t e Titl corpo ati.on, gi ve n aU .d add s ) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMK ETION WILL BE ISSUED. x_ GUARANTOR IS REQUIRED TO FiLE..NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health o A . PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVA S Date Re: Property of Aaya w/yo D �.��� ®c.�✓ .,��- Located at ��cse�,�T GAS✓ Section Block Lot Geritl.emen : This letter is to authorize a duly licensed professional engineer r. 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 wirn this mat-cer 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,,-,.an : a 'uxlam .County _ Sani- _ - .Lary Code. ! Countersigne P.E., R.A., ## Address Telephone Very truly yours, Signed � a,,- -00D /5��. -o&oe .moo OwnP_ of Property 1�3 Addr 9 Telephone J Countersigne P.E., R.A., ## Address Telephone Very truly yours, Signed � a,,- -00D /5��. -o&oe .moo OwnP_ of Property 1�3 Addr 9 Telephone 34 Columbus Ave Putnam Valley N.Y. 10579 914-760 6344 Glenn Rhian Date '6/10/15 15 Crescent lane License # 1137 Putnam Valley N.Y. 10579 Septic repair * 1 14.0 B 1 12.0 * 2 23.0 B 2 15.0 A 3 32.0 B 3 21.0 * 4 25.0 B 4 40.0 * 5 35.0 B 5 46.0 A 6 48.0 B 6 55.0 ot it CI PUTNAM COUNTY HEALTH DEPARTMENT �Z DIVISION OF ENVIRONMENTAL HEALTH SERVICES _... .-- _. .. ��.. a.► P_ OS�L: :FO.I.SEIAqE.RITI?9EII _S�YSTEEI R�➢[I� -. 1 J M0 Internal Use Only PERNIT�#'; -�- ❑ ❑ Repair Permit issued in last 5 years Mot in Watershed ❑ lJ Repair within - Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION Ura CL M Uce if 6 C, vi. -e— OWNER'S NAME MAILING ADDRESS TM#_7 3— 0 PHONE # qj i-_ 3aS-JsSA- 7 APPLICANT J c r�' L/ Cd+ r, 1, Name & Relationship (i.e., owner, tenant, contractor) DATE. FACILITY TYPE r/ ��� PCHD COMPLAINT # VA— PROPOSED INSTALLER . er^ ,�� PHONE # VY ADDRESS - v , 6.04 AWl -= P�,. L EGISTRATION /LICENSE # I Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and a ent of the repair. I, as oWner,agree to the conditi n on this form SIGNATURE TITLE 0 DATE (owns(r) . .,.__._ �...__._. 1.' iiti�sa�tic" in�taii�r, ��r' eEiGcarrtply�iti�tiie -co��ditions��of -this pdrmit•fGr-tF;e- septic- systel��i'�ir.,�, � - ,...�_._:._.,..�_.::F SIGNATURE TITLE �L° DATE bi (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INITr-DWA1 I IQ= nNI V Proposal Approved Proposal Denied ❑ 411, A 6h j 4, /-�)& I spector's Signature & Title Defte piration Date Repair 2roposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIMION OF ENVUtONMXNTAL HEALTH SERVICES DESIGN DATA SHEET-. SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: 11—ehlo"7 A�27/ Address: � CIVI-) -a Z162— Located at (greet): TM # mublelpanty: �� b7ckh Watershed: SOIL ERCOLA TEST DATA Witnessed by-. Date of !re- soaking: Date of Pemladon Tat: Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. I min for 1-30 min/inch,:5 2 min for 31-60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Foam DD47, pg 1 of 2 Putnam County Department of Health Division of Environmental Health Services SSTS Repair— Final Site Insp ec c ion Date: 3 7,// InspectecIbb:.., Installer: 0 *,_ cStfeef OMM _eownerll Town: Repair Permit #: TM # 1. Type of System: Conventional ❑ Alternate 0 Comments:* 2. Se tic Tank I Yes No N/A . Comments a. Septic tank size —1,000 ... 1,250 ... other ..... 7 il ) n I b. Septic tank installed leyel ....................... c. 10' minimum from foundation .................. d IDWrihiatinn Rny Additional Comments: RFSI Rev - 011312 i. All outlets at same elevation (water tested) ... ii. Protected below frost .............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box -- 0ioperly set ............................ f Trenches i. Sy stein completely opened for inspection ii. Length required — Length installed W. Pipe slope checked ............................. iv. Installed according to plan ..................... v. 10 ft. from . property line — 20 ft — foundations ... Alli 1, vi. Size of gravel % - 1 V2 " diameter clean ...... IFJ vii .-I Depth of Gravel in trench 12" viii. Ends capped ................................... g. Pump or Dosed Systems 3. SewaLe System Area a. SSTS Area located as per approved plans V b. Fill section — c. Distance from water course/wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... . b. All pipes flush with inside of box ......................... 17 c. Backfill material contains stones <4" diameter .; ....... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse f Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES F®R-SEWAG&T —R T-MENr -- 'f NVA EiRAjIR YES NO Internal Use Only PERMIT !,, Q,h_, ❑ LX/ Xepair Permit Issued in last s years ❑ 6fin Watershed ❑ Repair within Boyd's Comers, W. Branch or Craton Falls Res. Iff Delegated ❑ Repair within 2W ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION - TOWN XONE# TM # �, t "1 - Aa OWNER'S NAME '/��/ MAILING ADDRESS l 0 APPLICANT Zeci'Jt A4, 0rft i.*Ai,oA4— SSf ral%�wc (41 Name & Relationship (i.ef, owner, tenant, contract�J DATE 3 ! r FACILITY TYPE �eS (G4t o� PCHD COMPLAINT # PROPOSED INSTALLER Ar Gyr— — PHONE # ADDRESS 9CI MrA# fe rwbLtq REGISTRATION /LICENSE # I134 -Cfrorn Prowsai (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree t the con,4tions stated on this form SIGNATURE P TITLE �Gi.ij� /' DATE oZ- (owner) _, fv The. sgptiq ins er, ree..to comply with th conditions of this perMit.for�the septic .. ysterrt., repair SIGNATURi"~ ,_ -LE C�oYf�CiC .....DATE..:.. (installer) Pro al apAmyed with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfiiled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Dat6 ExpifatiorvDate Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION .OF ENVIRONMENTAL HEALTH SERVICES •O..:Y r:.!S'RYI l•:. �1:: - _- .PRO.PA.AL.FIDA.SE.,.�6E.'f EiE,`TA�NT SYSTEM REPAIR m�-r^ _ e A' +t s°9 ieR.e'T- �' .., , xx, � awo.w -.r .. . ••�vr�.}�,i:E.'4.`� . m .m�....::.::iw.:Fr:= ee�'.`i.,,p �;;.p YE NO Internal Use Only PERMIT Lr -' % \--' ❑ ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION l� Cft TOWN TM #_ �3;, OWNER'S NAME PONE # MAILING ADDRESS w APPLICANT k tS Z.1 tuai' � . C4-6r.- . e4l 7e'� s Name & Relationship (i.a(, owner, tenant, contractor) DATE gF'�A_�CILITY TYPE g!e-SUeA 6,( PCHD COMPLAINT # PROPOSED INSTALLER cGlr*\ Gnt-- PHONE # L2� - i ? ADDRESS AICo I REGISTRATION /LICENSE # �® eskOie) A.)`S 0%4Q;1- Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree t the co `ions stated on this form SIGNATURE TITLE DATE (owner) reet� orriply-witi,'th conditiohs -of. this; perm /_itforthq.: eptic. y temr pair;�;i :;: F SIGNATURE T LE L"co�,o( Y1a,� DATE oZ ig, (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 rI 0 g. UNffED STITES AW Cus, 8RECEIPT POSTAL SERVICE 4 SEE BACK OF THIS RECEIPT pay to KEEP THIS FOR IMPORTANT CLAIM RECEIPT FOR INFORMATION Adfta YOUR RECORDS NOT NEGOTIABLE sarw mmtw Year, Mmok Day Post Office A=nt Ckkt 21155120245, UNITEDSTI]TES ow POSTAL SERVIff-, SIX S*W limbber ....... . . UA 005m and Dmft 211551c02.4:.... 5 �t..rs:,,,. _,: :w..�w3;: = ;:.E.,' 00 .......... ..... fa y tD Mork iA L f Address f (PAD :.K.&AWAIPA/ F,&fWAr,,- ble 6 -m SEE R . B4*i NO NEGhA9I F ONLY IN THE U.S. AND POSSESSIONS 4000008002 .2 L:&::S 5 120 24. 0 a �, -�, '(Lr ° -:nY & -;i, ,v �=A;K s •Ii+t.. 1, -• .':\ �,la !'T. ^, eL r � + x 4 APPROVES SEP4 1974 ptll yfON OYISION OF - I ENYIR7H1hRN ML HEALTH St"Cr a �, -�, '(Lr ° -:nY & -;i, ,v �=A;K s •Ii+t.. 1, -• .':\ �,la !'T. ^, eL r � + f 7, 1• i' q II r { ✓• i �• _' -(mot f. ./.�•BX.� •_. ._ �i 34 r • C %'L'IvG �F i liJ = ✓"�N G 2F.aiyr�no4} NO TRUCKS:MACHINERY,BUILDING MATERIALS NOR EXCAVATED EARTH SHALL Bfirt. ALLOWED IN THE SEWAGE DISPOSAL AREA. CONSTRUCTION OF THE SYSTEM ISy;, TO BE IN ACCORDANCE WITH THESE PLANS ANY REVISIONS THERETO AND THE+'• RULES AND REGULATIONS.OF THE PERMIT ISSUING GOVERNMENTAL AGENCY.' S BUILT PLAN SEPARATE ..3'EWERAG,' OWNER: LOCATION:.. :,•� ,.�M CONTRACTOR:':�I'�41W` "`r" DOLPH ROTFELD 512 MAMARONECK AVENUE, SYSTEM, ..1 iv.. _LO -iASSOCIATES.. 401TE PLAINS,NY. '