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HomeMy WebLinkAbout3487DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.20 -1 -12 BOX 28 03487 I 1 IN .11 11111 1 1 III fro V- ]?dJ6, YL 4:* it 03487 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .......... �:7 p.��U NJ - Internal Use Only PERMIT # ❑ OVRepair Permit Issued In hot. 5 years Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Craton Falls Res. ❑ Delegated, ❑ Repair within 200 ft. of a watercourse or DEC-mapped wetland ❑ Joint Review SITE LOCATION 5'0 �AX-rg. r t, L LA v.6 TOW N AU -f NlAt t1A!t* TM .# -73. 20 --1 12 OWNER'S NAME MA49 AVA-r- PHONE# --k ,. MAILING ADDRESS S-0 V APPLICANT :70p Name & Relationship.p.e., owner, tenant. contractor) DATE 7 -16 -- 2 /5 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER 7oi4 V,-',rEd 1!�eoe PHONE 0 171 -i40 ADDRESS -qll"iL-IUA-b A,-.C- REGISTRATION (LICENSE # 1072— 1v 1.0rD7 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 sWaim) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. A", -QF01-1C, 7,11-A- P- A 1, as owner,agree to e conditions stated on is f TITLE SIGNATURE AZ---% TITLE DATE-'7//,6 //J- (owner) 1, the septic Installer, agree to comply with the conditions of this permit for the septic system repair --- §cAAtu'JAE 'TITLE 'O C ` ., DALE ProRM gporoved with the following conditions: 1. Procurement of any Town Permit, R applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, In duplicate showing: a. Owners 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 considerid 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. iu=aual "-CF: nNI v "Or Proposal Approved [D Proposal Denied' 00 Title ap, InsWoes,gignature & Da7t rat Date Repair proposal is in compliance with applicable codes Yes 0 No COPIES: PCHD; Owner; Installer PC-RP 99ML Rev. 2107 -- 1 7` 1� PUTN,AM 'COUNTY DEPARTMENT OF.BEALTH Division of Environmental.. Health Services, Carmel, N. Y. 10512 z CERTIFICATEOF CONSTR.1lCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �F i TO-in or Vplago I ted t Tax Map _ 8lockV Owner Tax Map Lot # Subd. # Separate *ewerape syst41„ 'built LY �? p Aildre Cooalsting of 'pql. Septic Tank and Other regrirQm*r"s Water Sppplyi public Supply From Private Supply Drilled By rM KM innq np Building Type. - .— Irstr�� No. of Bedrooms Date Permit issued Has Erosion Control Bean l ompleted? I certify that 00 gatGO(Q) as 14sted.serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of whiph are att4ehe6),.en$ in accordance with the standards, rules and regulations, in accordance with the filed pA and the permit issued by the Putnam County' Depgrtmwn Of Health. / Daje 1! ram jYV+R s-+�+� ,- i� Certit ed by P.E." R.A. .Address nse No. 66 Any person oq' Mpying premi" served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resy"Ing froepl loch u q9e. Approval of the separate sewerage system shall become null and void as soon as a public unitary sewer becomes available and the approval of the- ;private water supply shall become null and void whop a public w eT'ltlp ly becomes available. Such approvals are subject �o rrpdi(iaatbb .pr CASnpe. "when, In the Judgment of the Co r of Health, such r ovation, modification or change 1 cossary. lax Date s J Title BY � �.r.'lJ:� "s..}�xr ti'�' . i•: m.r.�.v -a:,f; fat �*+•�. •�- a1... ;.. _. , V. :'..�• y::a • - vY. :�r.; r: :r- w�T�.r..:_ . mac.-. �•�•� Owner or Furcaa8f r of Building M nic pa it VA W: Ly Building Constructed by L cation Street Building Type r 00, =J. Block 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 Aid 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- _:_;, Ems. r:.�.�..kb� -.: _. 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 19 Signat ` Title If corporation, glife 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 County Department of Health . DivisIn of Edviruumential Health Services Ala SSTS lair 1[+Y 1 Site SDavtver:a♦ : :Installer `yo .�. • Repair Permit #: c fit -- //�� « TM # 1. Type of System, Conventional ❑ Alternate O Comments: 2. Tank Yes No N/A ents L Septic tank size — 1,000.. .. other ..... b. Septic taok installed level................... ... c. 10' mininnm from foondation .................. d. L All outlets at same elevation (Weer tested)... ii. PmtkW below frost......... ............. iii. AM= 2A Original soil between box & try e. doadimft- oioaerh+ set .......:................... - u. Leogth sequined _'Len& installed iii. che�d . iv. Instilled according to plan ..................... v. 10 & from property lime —:20 $ — & mdations ... A Size of gravel % - t % " diameter clean ......... Vii.. D .qf 3mri_ in,+mnb 1:2" M!CiMIM........ ls.... ............................... 3. V. rtn - c. Dista ce Btom water conrse/v ds 4. W L Hoaxes properly Started and installed correctly ............ b. All pipes Bash with inside of box ..:...................... c. BadcM material contains stones 44" 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 ............................ 4dditional Comments: RFSI Rev - 011312 IV I M2- V( IVI L !V4 SEPTIC & rEXCAVAI ems • Drainage Work i,S.YdS.'tions • Grading • U6111 311 Railroa(LA,'venue Bedford Hills, Nei,"' k 10507 ?CIO ?a S-1 L t. tie el c le &1t1j -73, d 0 4L 73,90 1. P L F Xd POC c i7v 6-qti-,4 r rid Of A 'UNITE, SEPTIC & EXCAVATIONCORR Sept..( Systems • Drainage Work • Sites Developed �,,.�andallons *Grading • Utilities • Trucking i", "" "f ""tchemcr, Pumam & Fairfield Counfies 311 Railroad wenue Tel: (914) 242-1999 Bedford Hills, NevgYbrk 10507 Fax: (914) 242-1909 q: ww.unitedsepticsystems.com D 570 f -5errl'r- A--t - ----- ------ 5% D 570 f k ?,PUTNAM COUNTY �DEPARTMEr k Divfsfon •of Environmental Healih Services Tt f ^ I ; CONSTRUCTION 'PERMIT FOR SEWAGE - DISPOSAL SYSTEM I. - rs, -�•1� �r-.'R'+,y �/p .A7/ �4�� ��.�„�hL.Y'�I +1 jam:: ,jv ��� i � �.r.,.— "aSubdrvision i > Owner'' K. Buildin9` TYPe '�` 7 �,C: `�� ,Lot Number of Bedrooms F K rc .. Separate; Sewerage.System to ctitl5ist sof � � ' 'Gal f5 ptic T p!< �CAr✓is /yJAGLV? To be constructed by „ } v ,Water Supply '`NOE23 A.y Private" Supply to be drilled by r i v < Address�� �-a.��- Qther: `Requirements 7.1I� represent thatA' em wholly and - compieteiy responsible for the design 6'hd,;IOCAtiP6� 'ot,iO above described: will be constructed as shown on the approved amendment there to and n Counyy,'DepaYfinent of Health,.,and that on completion thereof a Certrficete of Const submitted'yto the Department and;,a written, guararitee will be,furni ;hed the owner place : in good _:operating, condition any .;part of said sewage disposal system during th. ante of the approval :of the l ertificate. of Construction Compliance of _the original.sj will be located'as shown'on the approved pjjan'aniithaf.sa id well wilVbe I,,_ - I I ..a cord Date , ✓Vv' �� ���Q Signed � �"_� zit � � 'uAifdress •_•2 ©�O 5"i91N1:!��G'z --�' / .. APPROVED FOR GONSTRUCT;fON Shis approvabexpires one year fromthe sdate �ssu ,revocable for :cause or may be amended or modified when`conside` necessary by.;fhe C ;require' a new, °;permit Approved for disposal'rof, domestic �taryasewa and p ` I�•�Date T ?l���7' By .. CS�kOFt HEALTH - ^armel; iN Y 10512 n r Town or V iilage � duress .So/rJE.eS"�T -�A PUTN�A%yl !/.rsf iV ofal Habitable Spaced .T •_-Square Feet lineal •fee't'rt X ,widthi trench duress p;-I Jv— - > z proposed syst �ij . a e sewage disposal system cordance'wit per s;.r r a ions o e 'Putnam :Pion Comp n'=satisf �p issioner of Healthwill I. f builder'.wil . i �� ild •tha Said Ii- succes3o Aa �r�- , ss Y ;... ,.. , .., .. . fo 9 thedate of the -issu- e well described above ce with i �'t ndar :reg I ,i ot;the 'Putnam P.E. R.A. i awnless constructo g has been undertaken ".and is nmissione� of Health 'Any change or alteration�of constr.uction ersupply' ti^ _.....__•._.�`- ^s.•.�wh ..e.•r.'..wc:"a'`.u... v.. PUTNAM COUNTY DEPARTMENT OF HEALTH OF ENVIRONMENTAL HEALTH SERVICES _DIVISION gyi:a::yy�y'�aZU..i e'%�+faw.wli- r'•�t'S +�., v= �fr..':'ii ay.�:.. ,. �+.} �:..` �j• �. aw:, yY{ jo::•` Y' ��i'-- �.. a.•.- ut»+• = �: k. r•.° Tlv :`- a'.�.- .m:'�.r.7vi�•i��.r DESIGN DATA SHEET.'- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner c.1y/s �4z %. 2.2 (j Address Sc. 4. ' Located at (Street).., Se6.d6 a o 9 Block Lotf1� (Indicate nearest cross. street). " Municipality Sou: wA, �/�c r ;� y� Watershed�cfs�i C 'SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBriI.TTED WITH APPLICATION, .. 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 Mirvin.drop. Inches Inches Inches.. 2 c, f /.S-' . C .:c'r /-s /9 L ...- . Z�y y ! '' �', 6' `hri✓ /... --r 4 5 1 2 3. Notes: 1) Tests to be repeated at same.depth until approximately equal soil rates are, ob- tained at each percolation test hole. All'data to be. submitted for review.. 2) Depth measurements to be made from top of hole. a..N 61'.a•.v .nw T J24.'�'t',N�lf �•'Fr�. •+-.v ��'"�va S.N LT�• •yb .w�•� T �S,y�.Mt's Zak,N L. L J...':... sib.° �JL.S'_ --_'. '1 1rY1 tlV61p• DESCRIPTION OF'SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. ,HOLE NO. HOLE NO." . 7 �J"G -197"• G:. L . 5 cr- " T'o i° S�o . L. 7 J z° Sa, — 6". 12TT om, /C'.PiaiJ, ,G.D1�� G.2.rz�✓ .18.TT 241' 3 0" �, H 36TT 1 42'1 40/94 -7 48 TT S ITT CA o 6.0't 66TT 72!'_* _ 78 TT 8 4" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY tj', ,y��.v2� C�,ei�Ei1/Ti Co. Date A/D!/.28, /T 97o Soil Rate Used ,�"' Min/1T' Drop: S.D. Usable Area Provided :50cc±7S;,c. No. of Bedrooms', Septic Tank Capacity, lido Gals. Type Con/C, Absorption Area,Provided By %�L.F.x24TT 36" ✓width trench. Other Soie- To �s'L= " /NST/��L �/J 4-AAI ". 61F NLrw Name h! ,c,�o"�m r/d,�z F' Sig ature Address �o� �� �✓ /h��` mid .ev, " SEALS. q PUTNAM COUNTY DEPARTMENT OF HEALTH A01 �© �! ASS © 12'b00 /�ryAL ENGIN���� Soil " Rate Approved .2•.4 Sq. Ft./Gal. Checked by to . I N!57TA F- M 15Y LO LJ 15 MM4,UXP f4A M VA L, 1, rn Y W-Y , ir. C104-1 L Putnam County Department of Health Division of Environmental Health Services Approved as noted for cor.-ftraanco with (--Fj a, -,a L . -;dations of the CiA 11C, '4 MJtfeGt4 15�� 198 ,k' Pu �' cai— Health Department. I g a & Title Datb Wg- Ae, Nil -r 5Frnc sysTe rAKTRIPGS I.Ma— T.Vb TOWN Oc rUTNAM VW-911( Y. 15Y '4 MJtfeGt4 15�� 198 ,k'