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HomeMy WebLinkAbout3320DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.05 -1 -69 BOX 27 ol oil 0 11 J -, T, IL-1). , 03320 PUTNAM COUNTY DEPARTMENT 'OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION .PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or Village �i9/i7/� s� U0 ca yi Lot 'Job Subdivision f7 Owner SAS /� G�iC.E�SO/Y Address/ K70 .0 .o� .�=o D _,FT/L'fJ l/ri3GGE1.S� .%L! 5.:10 s7.9 Building Type � � •�`-�� -�� /•� Lot Area Number of Bedrooms Total Habitable Space �Z gyp # Square. Feet Separate Sewerage,System to consist of ��� Gal. Septic Tank -' lineal feet X C�,J�! width trench. To be': constructed by ��' X .S' Ci mlr.% co lep. Address OGs7Ah4AP'! ��` %" Al' Water Supply: /Public. Supply From Private Supply to be drilled by Address 4 Other 'Requirements I represent that I am wholly aritl completely responsible for the design and location of the proposed system(s); 1) tt th L, age •.disposal system above described will be'constructed,as shown on the approved' amendment'there to and in accordance, with the standards sstor � o e Putnam " County Department of • Health, and that on completion thereof a "Certificate of Construction, Coinpliance'.'satisfa yl E ���r•.rf`` "r of Health will be submitted to the Department „and a written guarantee will be furnished the owner, his successors, heirs or a n$b t�1 i�uilder�;t tit tiuilder will � .. place* m ood operatmg..condition any part of. said sewa a disposal a e of original ts' st m otl'an two repairs they o 'at+th' .# le gw �de b d a issu y p above 9 ante of 'the approval of the Certificate of Construction ,Gompli nc, ig ,I y - will be located as shown 6n; the.epproved plan and that said well will be, �n 'accordance with the standar �u es'. ,r o4e Putnam County D,epa /rtment of `Health.- k1 Date Signed' A hA Address '2a7a �' ✓:�J9i�- /1+i.E,E�'...J' tense �,. F ` I APPROVED F,OR CONSTRUCTION This ipproval.'expires one year,from the date issued .unless construction of qty' 'g u0 rtaken••.and is revocabl`e';for,.causebr maybe amended or.modified. when ; considered necessary-'by the Commissioner 'of Health. 'An ai�40 pp *KS>:at requires 'a new permit ,Approved for disposal, of domestic, ry 5e or pri ater supply ,only of'construction. Date” BY' Title. r Or PUTNAM =COUNT DEPARTMENT OF HEALTH Division of Environmental ',Health Services, Carmel, N. Y. 105122 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PO7X), 41 % V1 G Town or Village r7 Located at �� °' c Section pO� —y 13 Block Owner L11-'l,4S. A.; Lot a SL - -2 1 G Job Separate Sewerage' System built by '6:A_ a64) W��r 67fc'o Address- �' P '"e'er V- A). Consisting of 14900 Gal. Septic Tank '%Y/ F lineal Feet X 13 I� width trench Other requirements Water Supply: Public Supply From Private Supplyy Drilled By N -J �i .V IC 1,.f�.e -'iG J i e__7> ,A�,dddressG Ate" )LiL�ld cSi 2 0 *3 !r"L/ I i� 4v-% V kficr 1k J y / :( %riY /� �If�. Date Perm t ed ) AI 2 5 7/ Building Type No, of Bedrooms Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plan f attached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued by thf z Date Certified by Address \asAny person occupying premises served by the above system(s) shall promptly take such action as may be ecessconditions resulting from such usage. Approval of the separate sewerage system shall become null and void available and the approval of the private water supply shall become null and void when a public water supply bE subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, mod n _7� / r", '�,` cortFlt),Q,w �virofk,�(c9p s of which are m tirlit dpRart Sant of Health. l a. 1 R.A. o e the_C.QRipcfiWi 'i any unsanitary a c16k y sewer becomes c (aka j I Such approvals are ficati nge Is necessary. WELL DRILLER'S LOG AND REPORT .'Well county of Name of ]Flace .... City, Village ot/Town 57 ........ piii of well/ -Cl. Diameter Was well disinfected? 4�1 ft. in. gpni's ....yes .or .no. . Amt. of casing above ground ').f." Below 'ground.. '�O well sea'l, ._C10V in, V1W1V . :. � packer, r jaidker, cement grout out i Draw a well diagram in the space provided below_-,and show the depth of casing, the well seal, kind and thickness-of-f6rmations penetrated, water.....--i. bearing formationsi diameter .of drill holes with dotted lines and.. casing(s) with .solid lines;' WELL DIAGRAM :,FORMATIONS PENETRATED j' REM , Diameter , in.j.Depth Kind-, thickne.ss and.. Type of well. in ft, if water bearing Drilling.method. A yGRAD Was "'Weil dynamited. .,,,t,j �Z ... ..... .. 25- P V UMPING-TESTS' D 4 -1 7, C . 0 Static water level, in f t 50 below grade Pumping rate -in 9-P.M.- 75 Pump in.g.'l eve 1 in ft. below grade Duration of 100 test. ,...,.in hrs.i 7 121- 150 200 250 Draw a sketch of the property ,on the back of this sheet I .locating the well and sewage disposal systems.- 1;1.:._. . _ - T EST! Clear. -e--'_'Cloudy_T1arbi Turbid Recommended depth of pump.in• v ell-, feet below grade WIELLS-IN SAND & GRAVEL: Sand Eff. size­` mm lTnif.i- -C66f. Length of screen ...ft. .Diam* of screen in* Type of -scree . n Screen openings x COMfENTS: Drilling started Completed Well Driller Signature . _VTEhh- LOCATION SKETCH ljraw a ske`tcn `showing ,ou�ine of propery9` general Saope.of°'.'T °�°` ground,: location of structures', roads:, ditc�ies., watercourses, wooded ' areas�.swamps9 ponds, rock outcrops; sewers; septic tanks,-leaching systems for sewage, test holes, wells and. springs. Give. directions - and di- stance to .nearest community. Consider space between.lines equal to.25, 50 or 100 feet. Make top of page North:.-and draw-sketch accordingly. > > � r t .Fay 1 t tx 4 y \ - 5 " �' 5�t a ..� >x5' ::t i'!5 �, - xv a i a �t x V1, - a Lin , u l .,t,t - r :: A is . - S r .+k+. s' '� , r c 5s y r h a *1'�. e r 5 t_4 y r e b t R t > .; �' ' 'r f,_, .,,b r' < '3S` ar S� '7 y "t 5 i < 5.�. �. 4 y a "-yr ,g- y'4'^a, ,5,+. ''�F t iti, n s� 3:' y ?{ar F.- y> Y Kt. �""a k �+, S,,S , ' R ' ''� v'- 7 ., _ • - Y ..w a } S 1 �' +v4 S s ., ,,.. L 4 2 T C NTY E 0 HEAT r ` �� k NAM OU D PARTMENT F L H J' 1wr ,t�{" r ;. i kR iy�AF it S r V yt b. :r a v j '� .off ;.e L1, ..1 h :Y ? .! H D �x 11 > IUISION OF ENVIRONMENTAL HEALTH SERVICES fi� a % 4,. v. -^ t '1" ° ` t»d r N . , I `{ i A ,- �+ L ! •- L y G j 5. . M �� F 1. TZ, ..r ] y_ µr0 1. ` y l I pb t v ' `� DESIGN `DATA SHEET SEPARATE SEWAGE DISPOSAL SYSTEM 'h FILE NO 11 � . cr tit _ r }v v`.{ ,... � r. �'� � 1 > a yL? OwnerG�ti.QE'L�9 ��/�dE.P�S'aNAddresss Po �oSI�{ 1`t1T/1/r9�j /�iS1GGrL� �T 5 Y N JS,-` �Z }3 1 14. -�1 ^ f s7 ��t3 YxY �`' �_K�l '.d `� k_, 4 i'A, Si \ {1: r b''� Located at Str 'et F � S'T,a U " rSec o2 o3Block _ Lot: <4 his tit. s" £ k ; , .. _ '?? s qq yr }.. yy� �. is z1 v gc,Ti t r �,.v, �w,r t �_`� (Indicate gnearest cross street) ,�r„ s L .y 4 4 �. x ..�..j. � �$ ,' Watershed �/c .�i [J// ~ »r a Y S � �. �,:,t ti J .: .. �^ y 5 , r, . ... . ' C,�.v m 'k' t 1, T �+, { r S x b a r h° Municipality r u�nig�n xe."Li �' - , _ I I .. ;"",.,"' -i F 4 +".:.;i j' t'€"II '{ Y '"5. -+' } �a 'ri £' �,�.. .rR �.s -�:" .7 �^S 's. -i- v y ,`..' h , i k r 5 v t B'., B- , r ;`"i 'v` r y1. �2-'� 1 ;.. zTj s' afl�' ,1 ,,rn i , ' k:^ :t:`y .i,fiy .t °.:;i iti ,.,.,..il• „"t° t %.. ..,r>~ tz,"'i•,".�5, I b rr'. 1 Au . �:i'zr.�,u, �} a -° r 't .Sw . -,,. ", . �, SOIL PERCOLATION TESTS DATA REQUIRED TORE SUBMITTED WhTH APPLICATION ��• 4 r '~ r a �,,tt r 1 ? 3 ar r ry,, a _ �Ys a. riY n--a, ar .F" v A+ a ';. a R { ,h.- ~ 1 °N x �v 3 t `l... Hole #N > 1 � F � Number CLOCK TIME �t .' � x'PERGOLATI ON � � ^,° �� �. ' • � w:' �' 3 y� PERCOLATION , ! - "z Run; , �' ElapseA Depth to Water: Water Level _ N _V' t , y c ; Time Rr f ,Trom Ground ;}Surface ,in Inches,r�t r1 z Soil Rate> ,,y, �' - Noy ' "V,` 1, L - 4 'r. FF `r Start Stop Min " 4 Start = 3 "- '. t .s Drop` in �, Min '. :drop ► I t 4 Inches rf Inches » Inches , �. �,-, . ,s , t s i 7"` u 'k."" k -' �. h s t 4p.; t d P S n 1 r r.x ,, .7 � r r i.` 7. *s'rs °r_ r i I 11. 11 a. ? s-�' t.. /� }J 4� ' //t�� b�'.� ��.i $ d j a j,. (/,'.,!, 6%y V t_ �J [ S �` r �:.�} -•. , � 4 4 � �J.�l), X31 :.? i:.. �{/ OCJ �O ^�ti ',y ='�7 , �/ v a {G /��/`/ fr /(/ I' l /� /� /� ji {.. 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F�tv ~ J" w `° iy4r,� x T sa '` r a,.., a r F& .w aa'+ �,� i" i'", 't x J ra" a�^, t 3 r t., 1. Li 5l- �g "X�w • „a xi .. 5,. t.. ..n.. a,.w 1,. _ L._- Y..'`.... ,._.. ,.._rr..5 F3... 5. r2._ '.Yi, ' 'n. m,:' ._,e;. �'w .u.3 .5... 11 rt l 5 "", 3 i L C t} 5 {,r {� J '� "t \. ,k Y 1 i .,x -�� i A,. '` rwz th t w.. ^s�K„ .r y tv ^, :, t ° z L F d� 5 { ,Notes & _, xp It<< 2r y s a I c t Fq I sr 4X A .rz'a4 .T. , ' Z,% , , W 4 � f, ;,, a3 2� Y . ' . fir^ V. ,1) Zests to 46e re, a .d at ;'same depth Fun�til approximately equal :soil � °rates are; ob �I V. f �` stained at "each percolation test ;hole 'All data ,o b6, u i.tted� for review c" ry s r C T t n \ "4. lN,. .a ,�.#. L Depth measurements to rbe [made from top rof hole r y 7k d 'y.n, �, vrs �' x ty irl �k °v r° / k 'h a�.. ^tv' Lev' "3 vr°; �� °r tw s Y. >' ; µ� .� a >: x.. -w.... ".. r.{.. tR.. :_:,- .,.�2....e."_c..r.Y.::.•., . «�:':'._y __''S'_^ �h_ __ ? - -... _.__w.:' x:... ':. ".__ ... _1_.v,. TE'T '�T!P DA RF71TTRzTI ±'(1 RE- SUBMITT D i.,IT� PT_tPT;!%T _ - - - - - 'DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. ,HOLE NO. HOLE NO. 7 �7Z-19r j 70 6T1 of J. 1211 1811 i/ !+ 24 N 3 011 J1 if, .. 3611 4211 4811 5 411 6 011 T,E.aC.6.5' cLrs i1 661t 7211 78.1 8 411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date C%`1NC- 10,19-21 DESiGN Soil Rate Used ;:-::.Id Min/111 Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity O Gals. Type Cal-' Absorption Area Provided By �86.L. F.x24t1 367 1 ---width trench. Other Name Signature of N Address =o7o 3,'aw IV, i- c -64�5,< SEAL PUTNAM COUNTY DEPARTMENT OF HEALTH 9 0. 2 Soil .Rate Approved I..0-5' Sq. Ft: /Gal . Checked. by °N4L ENcjsE -V* e' OKM SITE MAILING ADDRESS 2 PERSON INTERVIEWED DATE PROPOSED INSTALLER /IS-Sv PHONE ��7- -- TM#.5�,� PCHD Canplaint # _ & atio ip (i.e, owner,tenant, etc.) TYPE FACILITY PHONE 1 - V V Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect: ... �- _..,.- . -.-.., �.� +. < «..,.. -. .«.�_..p�.... .....- su -. - ..,.....�... e, ..... ..W ... ..... . :';�,.�..........��'..� .�....._.....- v- � >.......a a.. .ry ^- ..r.a- ,o+- +.s...... .. e. ..0 e.- ......- .. ... �. ._ _..... Proposal approved Proposal Disapproved 's 115- & Title � Date proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel) . e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE,di _ D/�p� TITLE " j'� DATE r PIES: Mite (EM); YeUcw (dal ED; Pink (Apo cent) A a-,- Lake Drive ALA and 8-6842 Lake Peekskill, N. Y. Cletming Specialist ist of EASTEKN STA TES -SEPTIC (9:0. TRENCHING IMHOFF TANKS ANY TOWN OR STATE SEPTIC TANKS SEPTIC TANKS CATCH BASINS K. R. LIETZ & SONS CESS POOLS INSTALLED BOOSTER PITS Raymond K. Lietz & Kenneth J. Lietz CITY DIS. PLANTS OIL PITS Owner & Operator OIL STORAGE TANKS INDUSTRIAL SLUDGES -.S S-5 Dl?/ J C L,),,4 / ZZ. OWNER'S NAME SITE LOCATION PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRIONMENEAL HEALTH SERVICES 225-0310 -PIROPOSAL. ­MR - S130GE - - _]D1_SPQSA1r_,SYSM_ _REPAIR-, PHONE TK# PERSON INTERVIEWED ,L ),4 Complaint # Name & Relaft oftship (i.e,, ownerjtenarit, etc.) DATE TYPE FACILITY PROPOSED INSTALLER 1z w i r=ft -A-4 vo-S z-,ov PHONE Zz,!$LzLYS-� Proposal (include. sketch locating all adjacent wells): NOTE: Repair must be in same location and Of Sam type as original sewage di systm. Different location may require submittal of proposal from licensed professional, engineer or registered architect. Proposal apprp T? ,-7 X4_1 C Proposal Disapproved Inspector's Sigr4tTfe- & Title. IRKe Ko posal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b.. Site Street Name, Town and Tax Map number. c. Location of installed caqpnents tied to two fixed points (e.g.rhouse corners). d. System description (e.g.,, 1250 gal. concrete septic tank,, three precast 01 diem. x 61 deep drywells surrounded by one foot+ gravel). e. Installerl.s name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agen f owner agree to the above conditions. SIGNATURE ZkjLf 4C G TITLE G DATE N 1,1:"V: Vbite MD); YeUcw (Tam ED; Pink OWimnt) a Owner or PurcEaser of Building Municipality a //� 4'x�'-) Building Constructed by Section �L,� 7 _. A: 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-. C; a ,� _o- 711 - ol o-.L- or -no u La,-- • 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 day of '46, /Y 19 711 Signature L L14 IV/' Title 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 ..... PUTNAM C.QVNTZ_.DEPARTMEN T__0_' .-HEALTH _.. .. _ ".4; 'w i.+rASTa�wr: ry:t - e a a3 3:vas ei-s's: f a+ t a^ s. —� °. : "�..�.� yi>� a�:•�Pswr:�y a..r ; a.i4 a s?P ^l r... •DIVISION OF ENVIRONMtTAL HEALTH SERVICES Date Re: Property of ....�2So�l. Located at i'"(JrVcJ�' Section -o S, Block Loth" ZZ 2 it Gentlemen: This letter is to authorize /y/ „�. ' �c'�dr�i�,�:✓,p� a duly licensed.professional engineer 1/or registered architect (Indicate).. to apply for a Construction Permit for a separate sewerage system; to serve the above noted property.in accordance with the standards, .rules or.regulations as promulgated by the Corn.issioner of the Putnam: County.. Department of Health, and to sign all necessary papers ion my behalf in ?o rTLe!c:t-i0 V i -L-b t}1.;s. -"?2t e.r and7- tt: a�:4 ... _�...,,.o cwe. .w or.. �..�.r- s .,.� .'.x- .r•� .. �. o �.a. 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. Very.trrL,1�(Z rs' Signed r, ' 0ToTner of Property Countersigned: Address P.E., �, #r �124ac�� ���� Telephone 48eal ) OF NE Address �PKE; wa c, gc iR oo xq 0O,1� . 9YJ'9 ' r 4 Te1 e e hon a o �NA( EH6IN�EK�. � X7 U 4 V /69,L Z4 tO I 44 a+{s110F, VA 0 N o'"pe, 77""';;'R 2,X MIA XT INfIP, T % "N j 75 A- 'g qI 7q- tk g� �A iOp �EW P, V-, w-, T�v NWp� j7 77— -.77'7-� !zl lv� w , 7 7 AV M —T o "'j- gl, i. U I," OV, Aq "7 A, _7 MMY, P_ �aJ�pt 3 A 4� R-1 Ez N ilk & A. I "M i F 4 e 3� S .......... ......... e' MAP Nl -Al"J �l al S .4-,l d, "t py, P 4r :Oii i­a' -ji, 7 - yokzowq HgAW, N 4 Co� T- 4,4 Apr