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Home My WebLink About3418DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -25 BOX 27 03418 IN. , J� a,r' , ' IN IN ' INN IT N 03418 l3 -7 . a. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 "\ J CERTIFICATE.OF .CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL-:SYSTEM &,uTtyA.-IJAII. ,�_.:,:_,_.- `•ry Town or Village Located ate� �°� �/ ,y!'%3 Tax Map Block �^S Owner Ls' IV11%_S �eLYW /�i11 �i Lot f'� - 7 /J /ob j Separate Sewerage System built by id` IeA s La & `�f" �� J JL'ry Address , C)A^J r� -�� r , Consisting of Doc)Gal. Septic Tank and / � Other requirements Water Supply: blic Supply From Private Supply Drilled BY �/g��s��C1G�fi>c•t1 Address Building Type No. of Bedrooms Date Permit Issued ; Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above pro attached), and in accordance with the standards, rules Date M 4 42 ' Address Any person occupying premises served by the above syste conditions resulting from such usage. Approval of the available and the approval of the private water supply shall subject to modification or change when, in the judgment,o Date as shown on the plans of the completed work (copies of which are e permit is ed by a Putnam County Department of Health. ,,,U;!1 ,t ; ?v . . . �_��.:� =tea r asssssssr tl' mptl suc ction as may be necessary to secure the correction of any unsanitary a 1 become null and void as soon as a public sanitary sewer becomes eQ�ill en a public wa supply becomes available. Such approvals are f of Health, such r o tion, modification or change Is necessary, By itle i PUTNAM ,COUNTY DEP "" < Division of Environmental W f vffies, Carme Y. 70512 a . _ CONSTRLiCTIDN'?PERMIT FOR SEWAGE D(SPOSACSI( `� own or Village �ry l., jK Located at ia0 / 7 Block Subdivision Lot r✓ Job Owner Ad ass A a O `;ij Type Lot Area / ` Al- Building d Number of Bedrooms Total Habitable Space .n `�� /� u " � ± t.e� Square Feet_;• y Separate Sewerage System to .consist of Gal. Septic Tank 17-7 lineal feet X 4 width trench To be constructed by /,� /,� 5-7y C k-4T' f rJY:A/� �" "' Z - Address v y. Water Supplyi � Public Supply From -?!� °. Private Supply t be drilled by u C C ! C GL i Address Other Requirements t� I represent that I am wholly and completely responsible for th o t e sed system(s); 1) that the separate sewage dispose' system•,,d above described will be constructed as shown on the app[ov8d n ac ce with the standards, rules an regulations o e u nam `'• County Department of Health, and that on completion tier Cer j ru lo ompliance" satisfactory to the Commissioner of Healthwill, 'y be submitted to the Department, and a written guara�tpey I b fur er, �s censors, heirs or assigns by the builder, that said builder wflF place . in good operating condition any part of said sew�"g I 's he o of two (2) years immediately following the date of the issu ante ,of the approval of. the Certificate of Construction 'Co loan m any repairs theret , 2)'that the drilled well described above ?' :! will be located as shown on the approved plan and that saitl well, be led in a�q ith the andard rules and regu aeons of the Putnam .." County Department of Health. Date -0�- L/7- Sig . Address .Z ^ `- z OCK-` APPROVED FOR CONSTRUCTION: This approval expires one year revocable for.cause or may be amended or modified when considered requires a new permit: Approved for disposal of domestic sa itan Date ! By P.E. R.A. License No. the date issued unless construction of the building has been undertaken and 'is ary by the Commissioner of Health. Any change or alteration of construction i nd /o riv to water supply only. Titles WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH Division of -Environmental Health Services COUNTY OFFICE -BUILDING - CARMEL• NEW YORK This report is to be completed by will driller and sul-% :sited to County Health Department together with laboratory report of analysis:of water -Sam ple indicating .ylatr r is of satisfacior,r bacterial quality before certificate_of construct ion. comgliancejt_-i;ayedL REPORT MUST FEE SUBMITTED VVITHIN 30 DAYS OF V ELL COMPLETION I OWNER AME ADDRESS LOCATION OF WELL (No. 6 Street) (Town) d �GtT" ahl V t7k4 (Lot Number) PROPOSED USE OF WELL ® DOMESTIC SUPPLY BUSINESS Cl ESTABLISHMENT INDUSTRIAL FARFA CONDITIONING D TEST WELL OTHER ) DRILLING EQUIPMENT n E(4J ROTARY D COMPRESSED AIR PERCUSSION 11 CABLE PERCUSSION Q OTHER (Specify) CASING DETAILS LENGTH (feet) DIAMETER(inches) �j WEIGHT PER FOOT 5 � THREADED. El WELDED DRIVE SHO E I UN YES F� NO CA51NG t (� YES NO YIELD TEST BAILED PUMPED ® COMPRESSED AIR HOURS 6 GPM d YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specily lectJ 0 DURING YIELD TEST feet) i Deplh of Comple.ud Well In feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diometer of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) 70 0060 DEPTH FROM LAND SURFACEI FORMATION DESCRIPTION _ C+� O'..c✓ aC.GI P,L. Sketch exact location of well with distances, to of least two ermanont.landmarks. p '-'-- --j; Fcct » ;.z! lJ S Kj i i iC, �?l vri If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE orb DATE WELL C A%PLETED" // / DATE F y ORT ��< WELL O LLEn (51 re) r�_ -?_,. . _ ��. MW P' cipailty f. Block OX 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 CouTity.,Dep.art:ment_ of-- Health.:as_. to whether no � t ie- `-" ` " "failure of "the system `to' operate' was' caused by the lwillful or, negligent. act of the occupant of the building utilizing the systP"'. k . Dated this � day of �/�� 19 Signature_ 6 L", '% 4_/ Title_ If corporation, give name -/ and address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLA�� BEFn E CERTIFICATE OF COMPLET,I,ON 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 Owner or D4SA;'V Lf Building Purchaser of Building Z. ok-1 Constructed by �y /6- i � 140 Location - Street Building Type cipailty f. Block OX 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 CouTity.,Dep.art:ment_ of-- Health.:as_. to whether no � t ie- `-" ` " "failure of "the system `to' operate' was' caused by the lwillful or, negligent. act of the occupant of the building utilizing the systP"'. k . Dated this � day of �/�� 19 Signature_ 6 L", '% 4_/ Title_ If corporation, give name -/ and address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLA�� BEFn E CERTIFICATE OF COMPLET,I,ON 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'l1T`AM M'N'TY D1:1':1t0'`.'r. \T Or 11PAU11 DThTSTAN or r.• 1!1 �,�• . 111:: 1I -.'1'1t:_PT Rk'..f:C�'��.a ��.� -. ... r ....�. rte.. _.. �..-; � ' ...� r �...� --• � - -< - :�, � -, .,. <. - .,,... Date Re:.'. 'Property o fvtiWs �• �%L �an✓1� Located at L O G Seet±nn Block �� Lot Gentlemen: is t S This 1 tt r ,'�71v �iaR e. e o authorize a duly - licensed professional engineer 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 pro.mulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in t; connection c.,it h this matter and to supervise the construction. of said 1 i system -or systems in conformity with the provisions of Article 145 or 147, Education Law the Public Health. -I�as sand th -,.,Pu.tndm= " ... .• " Y -~ taxvyC6de. it Very truly ours, I Signed Owner of Property Cou ers4d: 1 f //C I� S �N� �� i.✓,q�j U c�i' Address. N P.E., `, T�� !Q �, - t CTA D11 ephane Address OHAULE-14 Jk 1L AM RNq B ER h 267 bA p y. " zM AMA4��,�C`�,, I'll. Y. 10501 �t� s�� `aaV, Telephone .�� d s .. zra:r_rr, sr.Tl TON.. -. ..: . _ -- Prop;rty lines or corners found . a , 0 0 0 0 Can -estf.jrr_ltc house location, . 0 , , 0 Q, 0 Vila. drivct-ray need cut P:u.,I)t trees be removed -note them 0 e 0 0 Is deep hole repxc en tative of entire STNS area Additional dc;cn holes needed. Sufi,':i.cient SDS area available considrCIMI) driveway • cut, house location, separation . distances, etc. 0 0 4 a , DE.-PT BOLE D;i a,pth: ; dater elevation: Rock elevation: � - . Sails descri -oti on: DWRA- .6 Date FINAL SITE II'ISPE,CTION.' InsD. by Date:- Cj. House located where shoi•7n on approved plan SM, loca.ted".where approved ....J ..�1. �w VJ.••..i v'aa ...vC.. ti.l 1 li v, .. ... .. ' %. 1 Slope of tile line and' trench a.ccertable Roos, allowed for expansion trenches . , _ Over 50 ft. f. rom swariu, watercourse . _ -- - Natural soil not stripped or SDS area unnecessaTrtit :r` . r r _ dec d _ . . . ., Z aL propo li ri� _ ..... - • . ' ._ .... - and - --- — 20 ft. From house . . . . . . . 0 0 0 0 Separation . of trench from house, well -`—` etc., follo-us plan ... o o, a o 0 0 , .,0 0 0 Nwnbor of bedrocms chocks . . . 0 0 0 0 0 Stcnes, brush, stumps, rubble, etc. greater - -- f:han 15 , ft . from nearest trench . . . . 0 0 15 Ft. of peripheral soil horizontal..ly, from trench .. p 0 0• 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Junction boxes- properly set Could surface run off from driveway, roads, ground surface, etc. cluannel • near SDS ,. 0. .area •, - 0 0 O 0 0 O 0,. 0 0 0 0 0 0 0 , 0 0 0 0 Uo °s 16t drainage annear 0.11. in "ea of SDS f�' RALL GRhDING OF SITE ACCEPTABLE q a t(h V IEW UhLUK bhhtt"J' Meets Std. Remarks Yes No DOCUMENTS ' >',�. - > ,i'-= "— -. ... .�. is =::.F , •` ,.. .. .. ` _ y,_ ..'-.., — , .. ::r.._a •e ,�... i..c House plans O.K. �~ Design data sheet j Peres presoaked? I i Min., 30" pert test depth j I Cont. results.for 3 runs I D. Hole log O.K., ; Corporate Affidavit for other than individual. I Authorization.for engineer .Letter from.Water Supply if.applicable ; .I If variance requested -such noted on plans & apps. DETAILS if change is proposed,) j Existing contours. shown .show new contours) Slopes for driveway cuts, etc. shown;_ I Water service line location Footing..drai.n, etc. location I Top ;slope, bottom slope of fill i Percolation tests and deep test pit location .Septic tank size and conformance•to std. I .3 B.R. house' minimum House-setback shown j but lbcx Ali- Water 1+/_L l,l1L!! ,)V I U. Ul . t.0 bLIUW11 i Plan and profile SW r ............................... ............., All . other .well,s- and SDS closer 200' a +a .:_.�.....:.,._. - .,_.T...... shown or reference made ` -nee -andourids =clea - Y ti U. r`7 y shown I_ .SEPARATION DISTANCES SPECIFIED OBT PLAN 10' to P.L. 1/ 20' to Foundation walls i 100'.to Nearest well i 501 to stream, march, lake,.. etc. incl.expansion 15' to Curtain dre,in ; I 10' to waterline (pits -201. i f 15' to storm drain.I ; 10' to large trees I i 110' from foundation to septic tank t i 5' to pipe from leader drain & footling drain • PUTNAM COUNTY DEPARTMENT OF HEALTH . »z.^t�..., s'!,t. - 'i i:d" q � -,• :. n; a. ..�,. :�;��[ -:�_:TiCr.0 =- +t;,_...,;•;�.. 3: -;ri. .;..� <,i... ,'7, -... . -�,. ,., u. ., i .. >, 'DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��.u�J� _t i2t ,�.�o� Address lee A t-lef Located at ( Street 4dicate �U G/ rt/ � P :Z Block�_Lot nearest cross street) /J Municipality d/,��y 06 ru7 ,alht,-1 46, atershed 1X,171 -1, / 4-CO Lcd OLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole . 7 3V,0 3Cl 10rf3 Number CLOCK TIME PERCOLATION 7 PERCOLATION Run Elapse Depth to Water a er Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches P/ 1 Id -I3 170 2 to Z. 7 3V,0 3Cl 10rf3 /0- 7J oT v 7 5 2 4 2 3 4 Notes: 1) Te'gts 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. s ' 9 TEST PIT DATA REQUIRED. TO BE SUBMITTED WITH APPLICATION ._DESCRIPTION-'OF SOILS ENCOUNTERED—IN TE-STHOLES --- DEPTH HOLE NO. IPI HOLE NO. HOLE NO. 1� G. L. � �/ Lci9�j . 7 Lo ±n �o - -p a 611 A p j 12" H q 18" 2411 .0 �91 f n � tJ' AJ e 30" 3611 �. `h2" 48" G 5411 c, 60" V 66" 72,. 78" 8411 � =; �311�DIGATEn LFVEL_.A II Et"H�OROuND WATER: ;:I5:�.EKC,,'OUNTERED INDICATE LEVEL TO WHICH WAT� LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY' 16/1.,. - Date — 7,j DESIGN Soil Rate Used_ j MirVl "Drop: S.D. Usable Area Provided S i J� logo No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area PfYovided By L. F. x24 5b :i width rent . � ri, L ��i DER �� of r Name g = lgna ure `�' � Lup - Address- / D Na is x/ x; THIS SPACE FOR USE BY HEALTH DEP` = Soil Rate Approved Sq. k ai'd c y Date �� o