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HomeMy WebLinkAbout3600DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -17 BOX 28 17 :: I I I Ism 0 1 IN, IN p 1 r y IN IN INN 03600 PUTNAM 'COUNTY DEPARTMENT OF rHEALTH i v.. 1 } D/v�sion of iF - rbnmefi )4410 Services, Carme% N Y 10512 .CERTI'FICATE OF CONSTRUCTION f OMPLIANCE FOR SEWAGE QISPOSAL SYSTEM Town pr Village - Located'at Section �3 Block 4 iA,vc,� L>x?v.`r ANC �6 �. ., Owner '. � � Lof � - I r /YIf3i�'G;� Address Y5%/ofiL Separate Sewerage System built by Cons�sUng •qf ' Gal. Septa. Tank / �� lineal Feet X 3G� " width .trench i her requirements , ,t r Water Supply- Public`' Supply From' " Prrvate Supply ;Drilled : By Address Building Type of Bedrooms Date .Permit Issued Has Erosion Control Been Completed ?" ` S4 '04,� y y O ruing the above premises were constructed essentially as shown;on the plans of the completed work, (copies. of, which are l ce-4, .that the s stems as listed se `attached) and :iri acdcordance With the standards °'rules antl regulations plans filed, and the,perm�it issued ;by the .'Putnam County Department of - ,Health: e 7/ l �1 Certified by `� x -PE R.A. Address % �eY Qai✓iE�' LA i7 /CY1 No 2 gAAny,person occupying= premises•,served by -the above systems) shallcpromptly take such action as may be necessary to'secure the correction of ;any unsanitary .. ., conditions resulting from such usage Approval of ';the separate ° -' rage system: stia become null antl'vgid;as soon as a •public; sanitary sewer` becomes available; and the approval of, the prrvatewater'supply shall beco'" null an void en .public:' pply becomes availa5l8:' Such approvals are subJect to modification or change when in the judgment oft e' Com ssioner: f su rev t n modMication or change is ece eery...° r Date. Title BACTERIA PER ML (Agar plate count at 35 k's C) COLIFORM GROUP (Most probable No' /IOOmI.) D TAL ppm. 5. t� ess, than 2 2 ,... e �{ 'y DETERGENTS ppm z A Asia) sss =ssss MOUnt Kisco Medical LLab0ra_tbry IRON, TOTAL ppm �kz ,: I 4� 34 .East Mam Street - 1 DATE COLLECTED t ; RESULTS ®F EXAPAYPld�T1O,V� OF dVATER i y 'OWNER,DATE rRECEIVED ..PNa le''`Croft iInco. K � 2/1:8/77 CITY, VILLAGE;' TOWN ` & /OR NPw11; OF;iSUPP,L'Y � tRRta• WELL COMPUETI01'eAEPORT 3171 ttttttt� ! PUTNAM COUNTY DEPARTMENT OF HEALTIA Division of Environmental lioalth Sorvicus COUNTY OFFICE BUILDING - CARMEL, NEW YORI< This report is to be completed by well driller and SLII..,:Vlitted to County Health Department together with laboratory report of Larogle:.indj at ng..,,y 1) compliance y ps -issued.: a REPORT MUST BE SUBMITTED WITHIN 30 PAYS OF WELL COMPLETION O OWNER NAME % �� On, 1,4fc ADDRESS f �j G+ `� IiC/ 0o (I `i / / //t�6� C /d •/ LOCATION OF WELL n (No. a Street) (Town) (Lot Numbor) Ile-�fJ�/Y�JI✓�fli PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT CJ FARM ❑ TEST WELL ❑ OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) o DRILLING EQUIPMENT CASING DETAILS COMPRESSED CABLE OTHER ❑ ROTARY L2SJ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify). LENGTH (feet) — IDIAMETER(inches) WEIGHT PER FOOT PR13E SHOE ((� (M 5 A NG U�- �/ �, %j',�4 ® THREADED El WELDED ❑YES Ln!NO IJ�YES �NO YIELD TEST HOUR G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR YIELD ((T WATErt LEVEL, MEASURE FROM LAND SURFACE —STATIC (Specify feet) (� / DURING YIELD TEST fleet) If �" Dcpth of Completed Well . in feat below land wrface:� SCREEN MAKE LENGTH OPEN TO AQUIFER (fear) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (fnches)'FROM (1081) TO (loet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch MCI 10Cetlon of well with distances, to. at 10831 two permanent landmarks. FEcT i., rLET AO 4,11 /'3G, LJ / I0(r tC' r •� /9 , Flee /c �&C�c 2.30 z d'. ('' ,�' %c% Af .� 4-- a If yield was tasted at different depths during drilling, list below FEET GALLONS PER MINUTE v DATE WELL COA1P�[T,ErD DATE OF RIFIPOFU WELL OF21L n (sig`nature)---- ' Q' V 09 41 or 'Furchaser of .But Iding pinicipality .u$lding Constructed 8y Section n lard Locatiah tl Street. dock Building Type Lot GU)AWTMY OF SEPARATE SMIAGEGE' _SYS'M1 I represent that ,I am wholly and completely reoponsible for the location, workmanship, - terbr�l,. conatruction rtud drainage of the .^,evage disposal system serving the above des - scribed property, and that it has been constructed an shoran on the approved plan or approved .,�r�nt-. thereto, and in accordance with the standards, rules and re,,,ulations of the �' , r County Dc Argent of glealth and retch �aarAt�t to the oraner his successors Y P a 37 S° Y t o heirs or nmeigns, to place in good operating condition any part of said system constructed by r.:e athich ' frails to ovierate for a period of two years imnediately folloiing the date of 9 hJn^ of the ee vane d [Sposa]1 t::• 3_em or any repairs made ve to t ch RQ7fit.01i n. d- Yet' °e:r..... d.... ..a. > -r -- -� - , r rci 8 m_d_ by fi 9 v �, . where. the failure to operate properly is caused by the willful or negligent act of the ,occup nt of the building utilizing the sy3tew. _ tss�uers�ignoo- firtner:.mg tot, to accept• as:.coi c1 i . ` t oz,-_ a i; gat on of the Director . of tha''Divis3ion of Environmental health Services of the is r County Department of iealth.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 systems Dated this day of Wee- -,. 19 77 Signature A `PitIc R? D. x: bt/©oo 7> o'o�C� � �.�.__ Place State. (Yf.corporation, give name and address) -' 000eo�oemmeeomo® geoom000mm0000aomomeom000meoeeoewomoomeeoeoe000eoe000meommoeoeoeoeeoe +oo ©o • 7XVE (5) .COPIES ARE MUIEED WITH FIVE (5) COPIES OF FINAL PLANS EEFOEE CERTIFICATE OF r COMPUTIOU WILL ", BE ISSUED a Gt1/1D�'aAT1C0it IS R UIYt1?D TO FILE NOTICE OF DATE OF FS.RS`T USE ®&� SYSTEM ► r' r m e ' 6100000 ®0.000 Otlm0000000e0 m000O0m0 G000000e0000C00e 0mmm0e m00G000 m0e00 e0000m000000 e0tl 00000000® `• -fvJ BDi�ia are ®f $nw$ron nt�b �eaath Services., P � ,: County Depmrt'mant ®f Health �. . - • .. V- , 1. h Y �'f .` AIL ' , ' !, Y hac - -1 ^ G F J i{. l• - _ a f> £ y T �'. ` P[ITN M :COUNTY;"DEPARTMENT OF HEALTH _. Division of `Environmental Health `.Services, Carmel, N Y. 10512 ff CERTIFICATES OF, CONSTRUCTION COMPLIANCE-.' 'OK'St, ,'A -Gt- DISPOSAL-SYSTG'iVl_ Town or Village Located at F t t' 1 Section Block Lot dob. SeP.arate•Sewerage:SYStem bwlt by ` > >' err -'^ / > Address ti " Jr' "�7 r it Nr r• fib . i i/ k 3r Consrstin9 of 1 ��� Gal Septic Tanker lineal 'Feat X ^ i r s __ width trench ' * 'Other requirements Water SuPPIy Public :Supply ;From• ,• •''�r;Pr ill ate Supply Drilled By "T "��`-���'�'��L" _JIB• _•••-. Address 'Building Type A'i�1` 5 i=ll r` ` �f� l' No. ;of Bedrooms Date Permit Issued, 7L Has Erosion Control Been Completed? I certify that- the,system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are attached), .and..•in .accordance -with the standards, rules and regulations, plans filed, and the permit issued' by the Putnam County. Department of Healtn. j§ Date ,� ✓ Certified by - -' P. E. R.A _. 3 'r Address `''• i�tn r L�'�ciJit « F t.� ! t' r s'.',?L tense No r �_`r''� - ✓�� i Any - person: occupying premises served by the above. :system(s) shall promptly, take such action as may be necessary to secure the correction of any 4nsanitary •:conditions resulting from such usage. Approval of the'separate':sewerage; system shall become null and void as soon as a public sanitary sewer becomes ..available and,the- approval of the ,private water supply shall become null and void when"`a 'public water ,supply ,becomes available. Such approvals ,are t "subject' to'•mcidification sor change when, in the judgment of the,Co,mmrssioner''of 'Heatth;'sOch revoca'fion, modification or change is, necessary. 1 _ � .r Dater t i gym Title t , � , '. F :iu 1 :.. .' i.4 .:..' S.. .i ..��.� ..Y ..... ... .. .. ... ...,. 7v. .. .., .lp — ...,.. ...e ._., ...v ,... _ �. .. f.. _ .J.- _.._:.'A...��•.vA. e.'3L._�_..x:.. CERTMCATE OF OCCi3?AcYC'f Certificate of Occupancy No ... 771100 ......... Application No .... `.7.6-��91(1 Family) Location of Premises ...Park Drive,.. Zot X16, TM 63 -2 -16 • API(.. C;;oft Inc o of ....Putnam Valley, .Y. having •� •• ••• ........................... • .• ••. ...V ................................................ :.k heretofore filed an application for a building permit pursuant` to the Zoning Ordinance, Sanitary Code and the Laws #n effect in the Town of Putnam Valley, Putnam County, New York, having paid the required fee therefor and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of ,the proposed strut a�ma comppliance with the requirements of the laws as aforementioned and that the said work ferule met every requirement of the laws as aforementioned and that the ' premises have now been fully completed and are ready for Zu"ncy,pursUant to the pmvisions of law, Now, therefore, this certificate of occupancy is her issued under the seal of the Town of Putnam Valley this ..1st...... day, of ......August ................... 19....77 r :.. Not Valid unless signed in ink by a -duly authorised agent TOVpV P N An d/4LLSY, -,YOBH of and under Otte seal of the T wn of Putnam Valley. . RE: K l U C-.11 _JLJ %j U310 %,L lAl, b iUll V Ulllt./1 GI 1I � �i��CII Park Drive, PV - TM 63 -2 -16 Dear Mr. & Mrs. Priest: Recently an inspection of the sewage disposal system and well serving the above captioned residence was conducted by a representative of this Department. Subsequent review of Departmental files indicates that a Certificate of Construction Compliance has not been issued for the completed sewage system, therefore, final approval of the construction of these facilities was not granted. While we realize the difficulty involved in locating older records, at this time it is requested that.you attempt to locate the following materials and forward copies to this Department to canplete our files: 1. Well log from well driller. 2. Bacteriological analysis of water supply. 3. As -built plan prepared by the designing engineer or architect. Procurement of these necessary documents may be facilitated by contacting the well driller, engineer, former owner and/or Town. - You s�rc�uld -be -aware -that proo't �of "approval of the sewage and water supply facilities serving this property may be required relative to future sale or refinancing of the property. Therefore, it is in your best interests to obtain the above - captioned documents. If there are any questions or this Department, can be of any assistance-in this- matter, you can call the writer or Mr. Hodgens at 225 - 3838/3833. Very I trul ' your hn Karell, Jr., P.E. Director Environmental Health Services JK:mk cc: E/A F/1 /jk/jay -4 M. O'Dell, BI PV File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 nA 11 �S'..C��if, CIA '`''� .4cf PUTNAM COUNTY• "HEALTH-DEPARTMENT �+ �-�i,. � .?P4 .r.«a tiesCK�::1Gw� +tl$c i�,ai ar, bP ;.i: •t,W ,'..C. ...,,: 3.a��•... .. -b u-;.. ..r r.^.. �. DIVISION OF ENVIRONMENTAL, HEALTH SERVICES ` . 'John'-M. Simmons, M. -D. ;.. : ".. ,..:Deputy Commissioner of Health, - FI•ELD ACT.IVITY<<,REPORT; -- Sheet ( of } INSPECTION 'NAME 4QlGsT"" Orig. Routine Orig. Complain ADDRESS PP2V. WAVE Orig. Request No. - "Street Municipality (T)(V).(C) Compliance Complaint Comp MAILING ADDRESS.:, Final P.O. Box Post. Office Zip,. Code;:•. Group Illness .. Construction - TELEPHONE' a .. ✓ Reinspection -. "PERSON IN CHARGE• Field, Sampling Only OR INTERVIEWED F,• Field Conference Name -:and Title DATE p. Gs TYPE. FACILITY r. Other TIME ;ARRIVED ., ". TIME LEFT 2 Explain -FINDINGSc 14446s Do NbT ° BAR- Tu w-- 511Vf�D As PLANS IP96PoSEts Ali 9pbop![�V Bn.,u11AD,�C G2F` l[�QT I'h ISice"hI •:C-,?Grralry cI...z 2�rr ,..a„c ,.6►w,r ;,P]STNA1VTT!"CO1 .,_Division • �C04StKUCMN RtRWT� ryTGR: SEwAG ivisl "..'..Building Type N U mber' 0. Luca gubd 476, Ade .7, .-,' Private -. Supply to be :drilled . . . . . . . . . . .0 Other 'Requ lreme0s 81 1 7, ' 41V represent In �-fctr A he --'kiesic, '' .above will be constructed as'shown on,the pproved County',,Departrrient of Fieta'lt6';,:, and ,t4#,or, 1. comlplettr ibn, th6fe rtmetnt, an, .,be -submltted,"to­'t'h"eJ 'Depa da" written ,guaranteie, 'A An good, operating con ;ante :.of the-approval the: -,6f"'' 4, ' -_-- 'n tsa as sh�,orthej� diolanad., ha 'M64`6iH -­Date 0 Ad- . APP; R, 0W EDY011-CONSTRUCTIC 1 evocable for :cause or.maylbe ame A DEPART MENT -,OF Sevrces, Carmel, A/ 1,0512­11. 97n or V Lot 9 Job, Odress *otsi 'abie,,so - Feet at S 7 k width trench ionYof Z the proposed-s 1) _that the' separate'sewage 'disposal system toLllid 116466&da -nc'e""w.ith" the!st'a!ndards ,-i6ligi,and regu7alions ot,: - the .-Putnam , el -*sat isiitctory ,tco thi-Cominissloner of .14lealthwill thjt-.oWnetr,; tiffs successors i.qrsoi:- assigns -!6y�lih'6"build;r-th6t said builder will, i"d.bf,-66 j�g)-Vda I , QC_ wi4:the-datti,of. the',issu- 5W.Ing-'1pe years folio 1. d_ ­1 It­ , ­, '�`the 'rfrllled� Well above - original,sys em or,any -repa repairs hereto; 2) that --ro- A -accord d' dance '%WthAhe stan ardsi-,.rulesi,ar!d regula tons of, the -Putdarri bate. lssbed-,Iur - i of the . . ,,,,buildin§ has ib�eien�, n ertaken and Is detr ;Health e 't h6. to f r a n of construction r supply PUTNAM,- COUNTY DEPARTMENT OF HEALTH DIVISION OF ER'VIRONMENTAL HEALTH SERVICES 4FkFr�B.'LIi3PTC�'A,`'`lU `":::-'�ZS�j'�` DESIGN DATA SHEET- SEPARATE S5 AGE DISPOSAL SYSTEM FILE NO. Owner, ' `� Address r' � Located at (Street �/� Sec. Block Lot (Indicate neares cross street) Municipality f ondi) V-0 P �,� Watershed OLATIO -T TEST 'DA.T'A REQUIRED TO BE' SUBMITTED WITH APPLICATIONS Rio e Number CLOCK TIPIE PERCOLATION PERCOLATION Run Elapse Depth to V47ater Water LeveI No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 3 4 5 I 2 3 4 5 Notes: .1) Tests to•be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. A11 pp data to be submitted for review.. Depth measurements to be made from top of hole . TEST PIT DATA REQUIlrED TO E' SU13MITTED WITH APPL._CA ^TON DESCRIPTION OF SOILS i ;;COU 11.11T•: F IN `iE,`T HO -,S - , S DEPTH HOLE •NO . I HOLE P.M. H LL No. .__. .. .. .. ... _.. .- ... .. .... .� • vv i'r. 31 —....� V'Kil•°N Merv. .. .` 6" 12" 18" fsu 2411 d 3011 3611 .42" 48" 5411 6011 EN INDICATE LEVEL AT 1�7ILCCH GROUND LATER IS ENCGUIJTERED � J� 667 INDICATE LEVEL TOW CH WATER LEVEL RISES AFTER BEI ;G E::CO ,,; =RED TESTS JANDE BY �}": Date _ DESIGN _ nj -1 :?at-- dr�/i��L�p� sA ide^..:: No. of Bedrooms Absorption Area Address Septic Tank Capacity � Gals. By_Lf L. F. x' �4 THIS SPACE FOR USE BY .HEALTH DEPART' ,r;T ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by, kau Q,�bt © i t �.+ r, WPT7;, K! FFSSIO��P� °,'u 111 t 1� ►�� °° �.+ • P i ! PUTNAM COUNTY -DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL. HEALTH SERVICES ,,:; -�•.. ,, .... d Y Pc- tl y........,. n-._-...._ tr. r.. en-!^ a ^.Y..- .•- _.�+.n.- .a..w,....wl�l .r. ... .. . -O ..dJ•. � -.. .yr.o.iry 1. n..r.a e... �. .. +1, •. .. �ni?.:: •Date Re : .. Property of Jn Located at "_t Sew �c Block, Lot f -Gentlemen: • . This letter is to authorize lei, a duly licensed professional engineer �. �r registered archi t (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 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 trul yours, Signed Owner of Property Countersigned: ';�` N Address P E., R.A., Telephone - ..... Ad ress. v��; °,Peoasgg °•'�c'��� �. OZ _ tN Telephone •e s v A o DOCUM11M .'S House plans 0. K. P Design data.. sheet Alin. 30" pert test depth Const. results for 3 runs i D. Hole IcG 0. K. Corporate Affidavit for other than individual t Authorization for engineer Letter from Water Supply if applicable If variance requested -such noted on plans & apps. I .A ho►. t I I I i DETAILS if change is proposed,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shorn Water service line location Footing-drain., etc. location I Top slope, bottom slope of fill Percolation tests and deep test pit location Septic tank size and conformance to std. - 3 B.R. house minimum i House setback shown �lS t� i= i } --eJ t � )Lt •- �.,�. i j�_�,t71t. 1 1'lJU a __ .._. ......._.._ _ ..... ._._ ! 4 wa�eir with J 11 50 1 L. ul .FL bilOW!l - ~ 1 Plan and profile SDS A-11 other wells and SDS closer 200' shown or reference made Property boundaries (metes and bounds - clearly s UARATION DISTANCES SPECIFIED ON PIA )' to P.L. )' to Foundation -,ral l s )' to Nearest well )p to stream, march, lake, etc. it i9 to Curtain drain >e to water line (pits -201) iy to storm drain ►9 to large trees 19 from foundation to septic tank i 9 to pipe from leader drain & foot 1 lCililc:L 1.' Y, Z3 t• I i f I n 1 V 1 we -,l.expansion i ing drain a ,x PUTNAM CQUNTY 4}DEPARTMENT OF HEALTH Dw�s�on of. Enwmonmenial, Health "Swices Camel W. YW 10512 JNSTRUCTION PERMIT FOR SEWAGE .DISPOSAL ,SYSTEM 'rTN/A/»^f /,4[LY r Town or illage y `. pp ka Subdivision Lot •� x i ".] Y .• rte -. ;{.., 1 IOn • Address �D ¢. ,:yca� o . •STC'� . Lot ` ' Building Type Area-'­ f 4 'Number -of Bedrooms �' a. � To; �Habitabl 'Space ��' Square •Feet, Gal Septic Tan Ime t .X, width trench 5eparate;S'ewerage'System':to consist of g0O 3� T.o be constructed` by /�'J:9/ -'L_E G /tiOLl� " //✓C ess D OC!O S �2EET . t i Water Supply 'Public Supply .From C Y: 3 'P,rivate Supply, to be drilled by IN RV x - - - Other' Requirements Vr l represent, that I am wholly. and Completely•respon §ible for the design and location of'the proposed system 1) 4fiat th pa te• se a disp em, above described -will be constructed as shown on the'approvetlryamendnient there to and;,in accordance with a standards, rules an regu a ions'o a nam i County :Department of ;Health, ;and that;on completion thereof a Certrficate of`Coristauction Com ence satisfactory -to r f ealth will' i�r Abe' submitted to ,the Department :an il a, written- guarante`e�'will be.= furnished the owner his`succ sons heirsor,assigns.b a iEtifei!;ti t uilder'will. a;place m "good .operating�'condition` any part of said sewage disposal ,system during the :per of 4wo (2) years imme o#�i�f c� f the issu- ' x ance� of ?,ffie app oval of -•the Certificate£ of. Constructan -Compliance iof ,the origmal`syste .,or any repairs, thereto; 2 t ruled w N etcr d above 11 �i` will be located as shown on.the approved plan and that said well -w be: n- stalle in accords a with tfie^ standards ru ^ta Niey o�� tp, utnam - i County Department of Health Date . S igf}etl C94�11v^ 9 ` Address ZC) d «L 6 No i 5 4P.0 WO VED F0R'CONSTRUCTION This y approval expires one year from the date „issued `unless construction of th '9t3jt ir� •has_ een wnd and is b, . revocable for cause or may,'.be {amended or. modified;when considered necessary by -the Commissioner) of Health Any or al�� truction ! ` requires a,. new permit r Approved for disposal of domesti c samtaty ewage and /or private `water supply only rIN- -- � A� ENG'1tiEEP �`,�wDate�.�r��� '_ '• ax ,,By Title (y 1 tM1t _ ( X -i Opl 'T -61 M/ FIELD CHECK LIST Date: InsT INITIAL SITE INSPECTION Yes No Comments Property lines or corners ' found Can estimate house location Will driveway need cut . . . . . . . . . Must trees be removed-note these . . . . . . . V/ Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . . . . Sufficient SDS area available considering driveway cut.,house location.,separation.. V/ distances., etc.. . . . . . . . . . . . . . . DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description: '11,-) Date: FINAL SITE INSPECTION Ins p. by: House located where shown on approved plan. SDS located where approved . . . ... . . . . . . Length of trench measured Width of trench average Slope of tile line and trench acceptable . . . Room allowed f or expansion trenches "Over. -50 -ft-.- e-rcours,e Natural soil.not stripped or SDS area unnecessarily graded . . . . . . . . . . . . 10 Ft. maintained from prop.line and 20 ft. from house . . . . . . . o Separation of trench from house, well etc. follows plan . . . . . . . .. . 'o Number of bedrooms checks . . . .,, . . : Stones., brush., stumps, rubble., etc. greater than 15 ft. from nearest trench 15 Ft. of peripheral soil horizontally from trench. . . . . . . . . . . . . . . o Junction boxes properly set Could surface run off from driveway., roads., ground surface.,.etc. channel near SDS area . . . . . a * o na . . . . . .. Does lot drain ap ear 6.K. in area'of SDS p FINAL GRADING OF SITE ACCEPTABLE REVIEU C111,;CK S = - T I. Meets Std. Yes No DOCUN1TaNTS House plans 0. K. Design data .sheet i Peres presoaked. t Min., 30" perc test depth Cont. results for 3 runs I D. Hole log, O.K. i Corporate Affidavit for other than individual ✓ _ Authorization for er, veer I Letter from Water Supply if applicable � A If variance requested -such noted on plans & apps.: ;o A' I Remarks DETAILS if charge is proposed,) f Existing contours shown show nevi contours) Slopes for driveway cuts, etc. shown 1 '04 ' Water service line location I � Footing. drain, etc. location I N' Top slope, bottom slope; of fill ! I Percolation tests and deep test pit location Septic tank size-and conformance to std. I I 3 B.R. house - minim..im House setback shown ! il 11t,.11j. il st- r-!1 1 .1 .UAf f jz.. .1ieloNi iJ­ U-Sv ...... I All Wa uev Wj_ *uI*da ,U 1 U. Vl. d,L 6L1UW11 Plan and profile SDS... Ali other- veils acrid M closer 200' i shown or. reference made Property boundaries (metes and bounds - clearly shoXnl i SEPARATION DISTANCES SPECIFIED ON PlA 10' to P.L. 20' to Foundation walls .00' to Nearest well I 50' to stream, march, lake, etc. inel.expansion ; ✓ 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees ! i 0' from foundation to septic tank ! i 5' t:o pipe. from leader drain & fooung drain PUI'NAM 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 C,E'a.aT, //t/ C. Address Located at (Street V,,2, Sec.. 69 Block 2 Lot 6dicate Hares cross street) /C Municipality.� Watershed ,O��,es� /L 4— SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number' CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 9•'00 ,9 3v �o Zc� " �' J, All �.s" �o• 7 /YJ�iI/ / �. 2 9.`30 /O'oo �a Ica Z�,�" �. '' ('• 7 o,", A/ 4 5 00 6,7 7 °00w.N 3 io•'Is le.',oes Jo 00 1i Z¢,Zs' "� 2,zs:: 71 197,411" 5 11 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. t Health Department Sol% Rate Approved 'Sq.7t./Gal. .z'S.D..27.6 (Revo 5-22-73)' Checked b Y D16to .— i'liT \<<`i CC " "IT l7i:l' RTNT. \T Or Iff'AUI( ,bTV1ST�� n1'r. :'!'r ^��-' ;'.:�'T': -� Si.Rt'CCf S_ �..d. .�.:�.:..w. .. Date_ /.07& Re o Property of 1? 1,162 -7' 411t.,G, Located at ,Q�}, /� �•���' Section �'3 Block 2 Lot 1� Gentlemen: .This letter is to authorize _% Z_ 1 �� • . 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 promul.agated by the Commissioner of the Putnam County.' -Department of Health, and to sign all necessary papers on.my behalf in t • i�j connection with this matter and to supervise the construction-of said 'I! system or systems in conformity with the provisions of Article 145, .or t� 147 Education Law, the Pab:1ic. Health -Law, and the Putnam Count Sani- tary Code. , Very truly yours t Signed _ -Own-of of Property {. Countersigned: �,�. ,4ypa42 97' Address Te.l:;e'pIMnae Nddress Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE (XVNER APPLICATION _..._ FOR ttYPh CAN `SUBMi 'An' 'To PUTNAM COUNTY HEALTH DEPARTMENT TO': Commissioner of Health - In the matter of application for _ _ _J E,oA.�.oTE_.5 —,:54 1CTZ �iSGo,r.oL SYST�/n /,!i✓O �,C1v ,9Tt (,V^7-4 iE' 5 ";,a t}' represent that I am an officer or employee of the corporation and am authorized to act for .!�tc — — — — — — — — — — (name of corporation) having offices at ope-p _ - y"_ _,11V_ i_ Whose officers are President —A �_DD.i ®oc® 5�' (Name and Address) �,� OVA �' Vice- President _ LD ®�/YV —� .��,�cle ✓� _ � c- (Name and Address) Secretary _ �j/ ,�.S iL ame and Address) Treasurer I and that I am and wi'li be ;individually responsible for any or all acts of the corporation with respect to the approval re p p pp quested and, all sub- , sequent acts relating'theretoo Sworn to before me this �_ay Signed of 19 )fo Notary Public -' EILEEN A. SUZOLDT �6yOTARY P U 6 L I C, S `3to f N 3 Ydrx z,.r :..y.. +A .4� h' i�� � � stc<<... Cc�: ^� ��/ Commission Exa r s i�ia,ch 3o, 19 Title — 0 ----- -- -, -- ._ Corporate Seal ;