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HomeMy WebLinkAbout3236DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -22 BOX 26 N7 . . r �I f IL � '�T �L H 6f ig Lir-ir qr -e 03236 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 ' rrER i i= rl � ' Y'C(Ut srfilcr UN COMPLIANCE— 'FOR'��SEWAGE DISPOSAL~ SYSTEM T -3. .. j/t• a,4, J, SIAM �. %AI.I:C Town or Village ' Located at /Z.C-t S C-I-R— " L-At.) G 1 /Z C;44 1 1 L-LS Owner SAN W Oc,-> E3 i I 1Lf Lot d 7 Job Separate Sewerage System built by �A , F I-T'j c. IS- j';$"7' m ' Address Consisting of Gal. Septic Tank lineal Feet X 1, with Other requirements Water Supply: Public Supply From Private Supply Drilled By Nc:q2_h-,AN A&4e•'fCn S elJ AddressL»L Building Type F'A -AMP_ Mr- a )C� No, of Bed F- `` Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed es nti PI s the completed work (copies of attached), and in accordance with the standards, rules and regulations, plans fil ,H * t b t Putnam County DepartmenVo Date TF I h7 G i/O -%,r % Certified by P. E. R, / $ Address �3 KA-7b N A H, y License No. � r�1_ Any person occupying premises served by the above system(s) shall promptly take such a t7 p F ° NP conditions resulting from such usa e, A g y cessar to secure the correction of any u'r 9 pproval of the separate sewerage system shall bet and void as soon as a public sanitary sewer, l available and the approval of the private water supply shall become null and void h n a . subject to modification or cha Public water supply mes available. Such appic ge when, a Judgment of the Commiss' ealth, su evocation, rfic r change is necessary's Date r ;I By Title 1� ,,.r - .,.....,._ .. PUTNAM COUNTY DEPARTMENT OF HEALTH v - itii:.;S_ e rvpir _ _ess � C_ arme% IV. -4-051-2, —/ 1. / CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM / W of PuINA^ VAI -LiE Located at C R EsA A(T LANK Section Subdivision Lot 17 owner ST- AN6(00b �y11 -pCQ!S _TNC. Address QNE ' �AM1�Y l�r: S 54 000+5 Fr: Building Type �l Lot Area -� Number of Bedrooms 4 Total Habitable Spao Separate Sewerage System to consist of Q Gal. Septic Tank L line: To be constructed by .6 A r Address Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements S i t. V.7 - Block 4fY � Job x Y J� Square ., � - �width feet X 36 trench I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage Upos above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions.o e County Department of Health, and that on completion thereof a "Certificate of Construction Compliance", satisfactory to the Commissioner p-iIj be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that saidti place in good operating condition any part of said sewage disposal sy m during the period of two (2) years immediately following the date, ante of the approval of the' Certificate of Construction Compliaext any repairs thereto; 2) that the drilled well destxi will be located as shown on the approved plan and that said well will th the standards, rules and regulations of County Department of Health. Date Sign v, P.E. F Address ` _A T e �A W M, V. ' - License No. 4 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertal revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of co remrres aNnew permit. Approved for disposal of domestig sanitary s�ge, and /or private water supply only. C �/ '4� s.i."� u- t _ r. - .� .. . �.s �:.. o _w <rc:�w..• .s_u- �.a+..= - w .,.. ,. . � - .r:... ".�'.."s.:.v'�'n•.:, «-+ar =:rA /W AM ms's „� :i °• . '� by Muni cip ality Section Location-- Street Block /7 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 build:3:ng utiliz?r__e 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 e i, .act of the occupant of th building utilizing the systenl--.� -, Dated this c)_�day of 19 ';'� Si gnat .Title If co oration, give name and address). THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE, CERTIFICATE OF COMK�jETION 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 } WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK : i��.-... �<:::_ �3�as ::cepori�ts..�r�:r�rntplete� day.- wellydr, id: e�' ax�d�sa�brri0.tted�to,: �atltiiy: kleaJ. b�L_ Deertrr. ��.. icythy'.. M�th.lab�ratctr�dg6�?S�vf:.o °:, -- analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. I REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ADDRESS LOCATION, OF WELL a Street) (Town (Lot Number) ......... 3V - Q J/ PROPOSED USE OF WELL NESS DOMESTIC ❑ EST B ISHMENT ❑ FARM ❑ TEST WELL ❑ AIR OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ❑ ROTARY AIR PERCUSSION ❑. PERCUSSION ❑ (specify) CASING DETAILS LENGTH (feet) / DIAMETER(inches) WEIGHT PER FOOT �f © THREADED ❑ WELDED O YES ❑NO G YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR 7 S/ YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Spec/fy feet) DURING YIELD TEST (feet) Depth of Completed Well 1 / in feet below Land surface: J G 0 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet)' DETAILS SLOY SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION. Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 1,9 a s00 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL MPl ED/ DATE OF REPORT W RILLE ( gnatu- ey a, PUTNAM COON' i7EPAll`1ME-7INT OF HEAQU DIVISION OF ENVIRONMENTAT, HEAL'I'h SERVICE Date Re: Property of ST'AWWOOD :ByiLDCRS Located at CRE-_5,41VT AA16- Section Block Lot �7 Gentlemen: , This letter is to authorize W , L- L 1A M k'�EANC •a duly licensed professional engineer y o% 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 connecrion with this matter and to supervise the construction or 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- tary Code. Counters P.E., RM Very truly you . Signed zl� Oraner _ Property Address k'Aro n/AN A v-. _ Address eAr 0 NA1� -�-• .2 32 - g S'4 Telephoned `~ Telephone PPROVED 0,, NEW PLAN Ne 4' -or Of F"# - k- 1 r,",*%M, 'f PN 1-- 16-, T R � A,77� ANY. ISION OF ON HEALI% Sn=' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner STA /V/ h/0 v0 �y c E �e s Address Located at (Street 02E SA J-r 4 „)E sec •. Block Lot /7 ica e nearest cross "street) Municipality. 7o-wA/ or PjryAM VAL1- Ey Watershed 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 1 10:04 /0:'0'7 3 10 /3 3 2/0::7 /0:/ la, 9 l3 l6 3 3 4/o.,-3( /0 :54- Z 3 19 22- j 8. 510:54 le-'I8 2-4 7— 2— 7­5 3 8 l lo: a 6 /0:/Z 6 1 /r /4 3 z 31D.24 /0:3'�) lS /7 2-0 3 4 :.S, 7-0 20 Z3 3 7 2-3 ,Z6 3 7 1 . 2 3 _ 5 Notes: 1) Teets 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. z.. 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" 5411 60" 66" 7211 78" 84" COARSC SAT/r0 V/SoM£ F'!n/ES ArJ-D ,.A Rat 5 yn/Es INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date TE Soil Rate Used Min/l "Drop: S. D. Usable Area Provided So d0 No. of Bedrooms _Septic Tank Capacity !2o 0 Gals. _ MASonlFh' Absorption Area Provided By 24. o L.F. x24" ,L OAM Address Z Z kA TO &1A M Avc . SEAL A��h/AH V. iyS34 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by it Date a W T JU ik KE404 6 Hai ';I' '� gm ion wa ivtx J MAGt11(dE�l1','BUII�UI�1Si', NO TRUCKS, MAtfiALS ;�itOR EXCAVATED .EARTH SMALL BE t A ALLOWED"AW T-49- SEV4W !'Dl SP SAL; ARr; Y •ST M' mm4tl�" 1 TO, bE"UN;­A"G qAMEs,?WjTti,,T RI�TQ'�ANb ' SE'-,PCAr AMpi".M RULES �'AND ��ibBUIN9�;-;�'GO,VERIME�NTAL-AGENCY, "111!; :s a W T JU ik KE404 6 Hai ';I' '� gm ion 4 Yt- J. 10v�-'Pv 'A wa ivtx J MAGt11(dE�l1','BUII�UI�1Si', NO TRUCKS, MAtfiALS ;�itOR EXCAVATED .EARTH SMALL BE t A ALLOWED"AW T-49- SEV4W !'Dl SP SAL; ARr; Y •ST M' mm4tl�" 1 4 Yt- J. 10v�-'Pv 'A wa ivtx J MAGt11(dE�l1','BUII�UI�1Si', NO TRUCKS, MAtfiALS ;�itOR EXCAVATED .EARTH SMALL BE t A ALLOWED"AW T-49- SEV4W !'Dl SP SAL; ARr; Y •ST M' 1 TO, bE"UN;­A"G qAMEs,?WjTti,,T RI�TQ'�ANb ' SE'-,PCAr AMpi".M RULES �'AND ��ibBUIN9�;-;�'GO,VERIME�NTAL-AGENCY, "111!;