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HomeMy WebLinkAbout3468DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -37 BOX 28 . 611 l 1 � ' � r I will . , � .I PUTNAM COUNTY DEPARTMENT OF HEALTH Re V . 3/ 86 4� Division of Environmental Health Services. Carmel, N.Y. 10511 Engineer to Provide Permit p ) 1 �f CERTIFICATE OF COMPLIANCE 6 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM .a. -. ..a .. .. .. �.:'�;- �t•_.� .►��. -•%tea on Permit q Town or Vl�age de -Subd. Lot H 4-, - ...... 'Tar 1Giap:,:: .. Subdivision Name '�s"`d �' � :+'�':; "'�'�f` / A NTH t �u o Renewal, ❑ Revlslon ❑ Owner /Applicant Name C� �f �4 0 r-i `- ✓��'`'r' O y Date of Previous lip liproval Melling Address • ��� �� �l Z �%� C✓�T !✓' �C�� �/Le Town- f / s/ Building Type Lot Ares,' J Fili Section Only Depth Volans Li Number of Bedrooms 3 Design Flow G /P/D a FCHD Notification Is Required When Is completed Separate Sewerage System to conslet.of /P C-1 UGallon Septic Tank and Cl `✓ % , J G t�GY r To be constructed by Address Water Supply: Pdbitc Supply From Address Oil— Private Supply Drilled by go—Q< " — Address. Other Requirements zftV % FZ 1 av 1. ^ l %_ ry— .cPV t . ,• -- represent that I am wholly and completely responsible for the design and location above described will be constructed as shown on the approved amendment there to County Department of Health, and that on completion thereof a "Certificate be submitted to the Department, and a written guarantee will be furnished a place in good operating condition any part of said sewage disposal syste ance of the approval of the Certificate of Construction Compliance Of th 00 will be located as shown on the approved plan and that said well will be install County Department of Health. Date Signed Z %%Z �f?L"1`rs Address APPROVED FOR CONSTRUCTION: This approval expires one year from the da revocable for cause or may be amended or modified when considered necessary by requires a new permit.. Approved for disposal of tlo��.me lest A;ltarywage, n Date �8G B� :poays m(s); 1) that the separate sewage disposal system xrdartc ®wi standards, rules an regu a :ons o e u nam (AIR8m1 larS�e satisfactory to the Commissioner of Healthwill S succeSit�tpheir assigns by the builder, that said builder will of tv . r2) y rs immediately following the date of the Issu- T� any ri&ts,$ retol 2) that the drilled well described above the , 'nda s, r les and rag u a ons of the Putnam P.E. �r R.A. License No > �✓ e ua�yobsrCOnilr" on of the building has been undertaken and Is Itrtaati8 ealth. Any change or alteration of construction ply only. /qty '' Title - ! \�f7L.i 13, l8 I — 3 `7 ENGINEER MUST PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # ST 41 Located at if 6p ✓�� /� / d Owner A•'t✓' j 11&77-- 1"J7 V < / Formerly ,[ Separate Sewerage System built by —v5 e_,Cf %rW,�; Consisting of " v d, a Gal. Septic Tank and o c, 4 F Other requirements f Town Or VilI IN f Tax Map i4 Block Tax Map Lot @ �f: //� Subd. Lot Address /G. �� -j�'� j� 14, Water Supply: Public Supply From Private Supply Drilled nv�% Address Building Type No, of Bedrooms Oats Permit Issued Has Erosion Control Been Completed? Has garbage grinder been installed? Ala I certify that the system(s) as listed serving the above premises were constructed essentially as of which are attached), and in accordance with the standards, rules and regulations, in accordant Putnam County Department Of Health. ,dJ Date �_1 / Certified by� Address Any person occupying premises served by the above system(s) shall promptly take such action conditions resulting from such usage. Approval of the separate sewerage system shall bete available and the approval of the private water supply shall become null and void when a pt eub)ect to modification or change when, in the Judgment of th Isj & V ✓siion�ler of Health, Date E?_ 3 1 i.J T 13 iJ _ —r, Rev. 6/85 6 i✓ �ow plans of the completed work ( copies 60 plan, and the permit issued by the P.E. R.A. 9. VAL nse No. >- 949!r_ a aacult correction of any unsanitary nQ vol as soon , '�� ublic sanitary lower becomes s► 4yp ailable. Such approvals are jalkmn, Lm"In' or change Is necessary, Title ( D PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION40F ENVIROiAL HEALTH SERVICES ,'1•! :^- =a,i .F°o Y..>'i"(' ^7c:% r +��- r�`_'n ai: c . =roc- �; �e i.. u; ;f -.� + - r- :_- ,:r•:if- + ^+$_ ^ +cam.. 71. /V Az- t�• ^^-� �-�.4ii.- .�..•�.�•� • Try- is Rr= �1�R^•.^ ti.T t ..htrDe.�I.�n..•L.'clgn.riF'•iyr r�.4ar >r:'�.••- •�(w.. Owner or Purchaser of Building Building Constructed by ' Location- Street Municipality Building Type ,;�x % P. / Section Block Lot Subdivision Name Subdivision Lot # GUARANPM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as sham on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors,( heirs or assigns,'to place in good operating condition any part of. said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the •. �_ "Ceriti- fixate_ f�,Cgnstru t Compliance" for the sewage disposal system, or any = -- --? repairs IDctCe �y 'Tile'�L'i3" 5iif:ii' SyStl Eiu; °nV2+� v�lu"&`-u� is t�ix�y JrL�a•Q: •+y!*� l s...: : caused by the willful or negligent act of the occupant of the building. utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam'County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dat_Qd this / day of 1997 Signature ,n. Title � Contractor (00her) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk LI Corporation N (if Corp.) ess II. IST. V. Vi. APPENDIX C !' FINAL SITE INSPELTION Data f TTQN Q�JiCL C,,� Inspected. by TI CJ�•$,1 RE vv,..YY. r�r..ls ^. f K —l'-. YES NO GE DISPOSAL PRFA a_ SDS area located as per aunroved plans I f b. Fill section - Dtt= of.plac--TL--nt 2:1 barrier . LCCTH W'ID'ifi P_VG.DPTH I _ c. Natsrz..l soil not stricoed d_ Store, brush, etc_ , greater than 15' fran SDS arm_ e_ 100 ft_ . fran water course /wetlar_ds. w' SF. -&•j=-- DISPOSAL SYST-"_ a_ Seotic tank size - ,000 1,250 �r� b. SeJtic tank �--:d l .el I c. 10' minirarn from fcur_c•ation I d. No 90° bends, cl °eancut within 10 fn. of 45' h----.d e. DIS =UTIGN EOX ( I 1. A11 outlets at same eleTr�t i en - water test" , 2. Protected be?cw frost I- 3. Min a 12 .ft. cr-tc soil between boxanatrenches f. JUNCTION BOX .-' rc per l set g _ �s < 1�' 1. Lencth r�:i rea i,z&n irs ta1 < _ 2. Dis -Lance to wate_rccurse rre sare3 3. L-ista -Ue acc —rd; r_q to plan I ( ✓ 4. Distance c_nta_r to center 5. Slooe of trench acceptable 1/16 - 1/32 6. 10 faet fran prcre_r tv line - 20 feet - fcLS:= Li cns ( I 7. Depth cf tr a_^_cz < 30 inches from surface ( ( I 8. Rocco allc',ed for expansion, 50% I I 9. Size of ravz 3/4 - li" di a*neter 10. Depth of c=avel in trench 12" uLvni un I 1_ Size of = 2. Overrlcw tank I I I 3. Alarm, visual /audio I I I 4. Pmm easil acce--sible manhole to grade 5 . First box bar =1 I I I 6. Cycle w-it*iessed by Eealth Decctme_nt I estiurat-ed" flaw re• cycle I I HOUSE ' a_ EOu-se lcc ted perr a=proved plans. I ! ,j ✓y�_ b. Imuexr of beriroars ( ✓ Wry a. Well located as -c--- apDrOVe3 lays I 1 b. Distance fran SDS area irp—asured ft. I c_ Casing 18" above c7rade_ „� a. d_ Surface cLainace around well acceptable. I OVERALL WORFU-91-SFTP a_ Boxes properly crcute3 11�4 t b. A11 i rtially hackfilled I C. All pires flush wito inside of box d. e. Backfill rrate_ria_l contains stones < 4" in dia- ete_r I ojr-,ai n drain installed according to plan I f. Oar`uain drain cut :::-:all prote&ted & dir_to eYist_wat= rcours� -- g. Fcctinc arairs d� scharge ii fran SDS zre h_ Surface water rot = cticn adem -fate i_ =osion contra provided on siooees greater th, n 15 %. DAVID D. BRUEN County Executive W DEPARTMENT OF HEALTH Division Of Environmental Health. Services Mr. Frank Sullivan, P.E. 2972- Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr.. Sullivan: July 7, 1986 JOHN SIMMONS, M.D. Deputy Commissioner Re: Anzorino SDS Constr. Permit Appl. Church Road, PV, TM 72 -1 -9.1 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are 'offered as follows: 1. Location of all streams within 100 feet of property have not been shown. Specifically,- discharge from apparent spring house noted as "shed ", east of proposed sewage disposal system (SDS); separation of less than 100 feet will require justification. ✓ 2.. Location of SDS north of existing well is not shown. _..�.. _....... _ .... :3.. nurie.d.,.fii; 16 �. -t3nk - 1n,_..i�i G.i_ni tx, nf..SDB J..s. n'Ot _shown. _ _... .. ..,Y -lrtiw.- ..4'cs r..a w.. ...w ...ah.+.- ....r..,w .. ..v ).a't -. -..y. ... .. 1 . -w- a:.... -, .. •i9 ^ -,w .. .. � .. . .. - 9 .u, an .w.s. w. • . / 4. 50� expansion area mu`st`�maintain `necessar'y" separation t�" spring. 5. Bacteriological analysis of water supply will be necessary with compliance documentation. 6. Departmental inspection on June 16, 1986 indicated deep test hole 1 was significantly less than the required 7 -feet deep. Adequacy of depth of soil has therefore not been demonstrated. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. JSH:amm cc File Very <truly yours, bxn8b James S. Hodgens Assistant Public Health Engineer TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 PUTNAM COUNTY DEPAR.[MM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS � FTT.'jT; �t41SWM7!1.4 P.�'Et1!'?' _ '7_ ? ©' ?Gy - :.�._ - -.q� �.ii. ar .r ry a. . -va��• 40 Yr_Y•. . . .�... . ��.`..:_ � 'f:�•� .. .r �.. rJ :.1... DATE: a tir r..tt �.'a •Y � .. d..... .. _... INSP. BY (Name f er) (Street Location) INITIAL SI INSPECTION 2. K ( () ✓ YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... 67X- . Will driveway need cut.oe .............ee.....v o o.. Must trees be removed - note these ................ Deep holes representative of entire SDS area...... D Additional deep holes needed ......... ..... ..... F c Sufficient SDS area available considering driveway cut, house location, separation distances,etc.. Adjacent wells /septics ...... ......... ........ Chi 9 ft. 9 ft. r"' /51cr�. ft. n� ` DATE: - D.H. - Deep Hole D.H. 1 Lot � D.H.,Z Lot D.H. 3 G.W.- Groundwater Lot Depth to G.W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock Soil Descri tion Soil Descri tion Soil Descri tion 0 ft. 0 ft. 0 ft. Roan allawed for expansion trenches .............. Over 100 ft. fran watercourse .................... 3 ft. Natural soil not stripped or SDS area 3 ft. 6 ft. 20 ft. from house.... ........................ 6 ft. 6 ft. 9 ft. 9 ft. r"' /51cr�. ft. n� ` DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMERM House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allawed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............ ............ 10 ft. maintained fra,n property line and 20 ft. from house.... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set.. . ...... .......... ........ mould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE... ..... PUTNAM COUNTY DEPARnMENT OF HEALTH - DIVISION OF ENVIR0NMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) REVIEW C SHEET �p- CONSTRUCTION_ PF MIT. ) f - ,[TV1r�C}� R� r .;... won•a =..T. L L' R6V4 YY BY: (Street Location) • �� ©D OBI QM O� Atli 0� 0� NEI ®M M«Z' a� ®M M= E■ DOCL]MENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole. Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area aanlion.Area; s_hc ?.;.gra�aa,tu,fl ow,.s»ff If- House Y[irnp�i'Yic. & U`'liOX bno�m &'L�erallea "'" -.°"° s - No. of Bedroans Wells & SSDS's w /in 200'ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Ciirtain,Storm,Leader,Footin4 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same Re: PUTNAM COUNTY DEPARTMENT 00 HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Property of Located at- . L�:;, / I (T V q1;-'7. Date oo e>101 Section —Block Lot Subdivision of Subdv. Lot # Filed Map.# Date 4,0 Gentlemen: Z4 This letter 44 a .4rize �S 'IV/(y�' /�.p� !. Jf �,/�J `� -oil r be .a duly licensed pirofe 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 promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers.on my behalf in 'Connection with this matter and to supervise the construction of said ys 'em or s 'ystems in conformity with the provisions of Article'*145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, ......... . 9 Signed i ned/A Owner of Pro pl�xy t ersigne 't"A 0 .0. 41 :24 4� C11a eell /fo /7 k" rI Address _4 Address Town .41 Telephone elephone / 1'Y51_ 6_15j * V 2- .' V ?' PUnM COUNTY DEPARIMENT OF HEALTH ...DIVISION OF ENVIRCNMENTAL HEALTH SERVICES DESIGN. DATA SHEET ,*SUBStJFAC,E: SELVAGE DISPOSAL _'.SYSTEM FILE NO. :.. - �'-�+�,. -.. ... -J�:� l'T,..t.`.' .S!'• �: - u,jz :. .. �, .„y"JSe�.`M -� :.• anra nciir *•xis ` - s_rrrJ�'X - :.'•; `: 4::5^� f'�i Z i '•`i: owner Address Located at (Street) Sec. 7 Block Lot !?r f (indicate nearest cross street) Municipality �� r1 Watershed SOIL PERCOLATION TEST DATA REbUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation HOLE N[kMER C= TIME PEROQLATION ` �' OOLATION Run Elapse Depth-to Water Frcm �b Le No. • Time Ground Surface es �' j Rate Start -Stop Min. Start Stop Dfop� `n Min /In Drop .. Inches Inches IncK9e O/, . 23 4- 5 /�. 31e C:' V 21 2 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. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS EIKMUMED IN TEST HOLES DEPTH HOLE NO. .-HOLE. N0,­ HOLE NO. G. L. 21 3' 48 51 69 71 89 gg 10, 121 13' 14' INDIWE LEVEL AT WHICH GROUNMTEg IS ENCOUNTERED INDICATE LEVEL To WHICH WATER LEVEL- RISES AFTER BEING ENMUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE DESIGN Soil Rate Used CI-5' Min/111 Drop: S.D. Usable Area Provided - No. of Bedroans —3 Septic Tank Capacity gals. Type..4 o _:5r,1'0 Absorption Area Provided By L. F. x 24" width trench Other Name j4 Signatur/i Address U� ° &'t . THIS SPA(2P, FUR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by y Date