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HomeMy WebLinkAbout3646DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -2 BOX 29 NJ IN r i 6 L� .1% r , . . IN rNN 1 :, I : NMI IN 1- NN a 1111 1 03646 ^°C'°'S3'^' "' TM_....'^•.^^.'*i: <- n -•,. -� ++ *,r- " aa^--c °rat '- r - r--s . -tom •,F +y PUTNAM CC),Y DEPARTM UNT ' '' { 1 HEALTH Division of Envi�onmentdt , 6a /thSe�wces Care/ N Y 1 CONSTR� 0512 JCTIU PERMIT FQR SEWAGE . DISPOSAL ;SYSTE ?t7c�iv _ oF.G/T. located at �iq/� -S Llii,dlY iii11S !�• %� ill c.�iGI7.G� �f- - �"'� J Lot own Owner US�i4/ /%�7i G Ct� - - /� �� Job Building Type i6 Adtlres's w�L�%2 cSf�L� Lot Area Number of Bedrooms Separate Sewerage System to consist. of /(%Q c Total .Habitable Spa a Gal Septic Tank 7 % Square Feet' To be constructed.bv ?�:: cSE�7� ` �$ lineal`- feet..x �� 1! zi Water Address X/Iyt . width trench j Supply: Public.SUO Ply From /20Gf�GLL� �j. t, Private Supply o be drilled b j PPY t , _ Y Ij Address Q ' Other Requirements yj- ] j . S�: Sg' `fit► . j I represent,.that I am wholly antl completely responsible for the, above described will be constructed asahown on:;the a and'Ydcat>n' �f County Department' of Health, ,an that on com le proved a, ntl ent t re to:aB'p d 'be "submitted -to She: Department P. lion there " !,.��°C r" e w th the standards. rules a separate , sewage disposal` >sYstern and a written ertif loge of: Cons[ruct on , ompliance satisfactory to the Com Place in good, operating conditwn any"- guarantee' w_ i be ance' of the< approval of the CerY Y part of said sewage 'd osy - -'•r, tl the o�rn essors,, heirs or assigns: b ;t r _ h su qr Jficate. of 'Construction Com' dl,. e: rio :of two (2 j, years" "' bW. eriithat 3aidfbu Ider will ' Y . he Will be located as shown on.the approveq plan and That said well wit , t^t a origin {L County Department :of Health. . immediately following the'date of the issu , em nY repairs thereto, 2j that the drilled well.lescribed above ln3 h'the stars ards, :r` es and r Date �L /G7 .%�j7/ °Qf �Eya egulations of. the 'Putnam; Z� Address P E R A 4PP.R0VIED FOR CONSTRUCTION This approval expires one �`�� eJocatile for cause or ma year fromthe date issued,,unles ;� construction of the b License No Y be. arnentled'.or modified whenconsidered neces' eguires a new permit. App[ovetl for• disposal. of domestic _sanitary_,sew a a,_.` -the Commissioner of Health. uildmg "has °been undertaken' and is r� ^. ^'� Any change .or alter'tion'of< construction:: )ate �^' / iNYr_ B y _ �4m ... Title �..�"� "' •I , 4 / 177 bA r 11 L TTr�y1 3BALTH PUTNAM COUNTY _ DE -ARC Tv i14 i q Ddvdson of'Envdronmental Health= Services, Carmel, N Y. 10512 i.adP� 1) ,i IANCE FOR;SEWAG.E DISPOSAL'.SYSTEM Town or Village I CERTIFICATE OF CONSTRUCTION ,COMPL Block -FA-#, o►h . 8 S G. Job Located at q�A Lot § Owner? Address idt J Off` � , JJ (� 4 w• h trench Separate Sewerage System. built by '� �[�� lineal Feet X 0 .. Tank •.; `; _ Consisting of Gal. Septic Other .requirements, ublic SuPPiY From Water Supply: c is> Private Supply Drilled BY -„ ,Address ° . Date Permit Issued t No. of . Bedrooms _� -` w' i • - . k. �A Building Type yrt x 4 j k eted�. SgHas Erosion Control Been Compl. �0 the, a artment of Health ' 1 ed essential) s shown on plans of he completed work (c °Pies of whieh.:are ; p e he Permit issu bY;, t Putnam County D p oa (>certify that She system(s) assisted serving s { s filed, an ions ^' attached)' and. in' accordance with .the st� duel e ek -�, P P#4' E• = RA I tifie License No. • ;f if any Date �. "`_ } ` t� Addr Nd 3rd �pp� ptlY take such action as may be n void as soon secure eahPublic sanitary s?w r bec mes i.� ^. y h�IT Such aPPro" is are j `jgnyarson occupying Premises served by the Werage system shall become null an I becomes available. p rova me null and void when a public water p Y 1 nvate water supPl ealth, such re ca n, modification. change is necessary conditions resulting from such usage. APP available and the approval of the p ��ubject to modification or c1h_aange hen, in the judgment of the Commissio Titl li / Owner or Purchaser of Building Bua ding Constructed by 1 Location - Street Building Type Municipality 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 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 County Department of Health as to whether or not the ' r -I � t � N 1 _'� '-y - �- llfui or riegiige2iC f ct'iillt v 'Oi Vile.- 5 :i e- vv o era -e- was °Cb'u'S cit u t,h6 w1 act of the occupant of the building utilizing the system. -- -�z- -- Dated this 31 day of .1A-d _ 19J.L Signature-- Title`c�s�. /� If corporation, give name and address) TWEE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CEF2IFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Diz Sion of Environmental Health Services, Putnam County Department of Health l`JELL llRI: LOG AND REPORT Well in unty. of -f_ ...:. .. ^,m �� s. a,:L • .�i �- �� Wig.; �,r rwu �-'.- P406 Ada.,es ete we dis- i nfecte am Owner Depth f w^ 0 i - fti ini gpm . ` yes: or no l� a Amt. of casing above- ground. seal in ft packer, cement,.grout Draw a it ,ll diagram in they space provided below and show -she depth of c::.sing, the w::ll . s:.al, kind and thickness .of formations enetrated, water �bearin formations, diameter of drill holes with dotted lines and 'casings) with solid lined. tWELZ DIA'al�AT2 F.ORPa TIuNS YE ? 'T1 T.�D REPT $S iameter, in. Depth 'rind, thickness and IType of well in:ft. if water bearing. ]drilling.it'_aod .m Grade Was well dynamited. I ( 25 y� PUNIF'IP ?G T_,TS _ Details 2 - 3 Static aater level, in ft. f 50 . _ ow °ride pumping rate ' in gpm 7.5........ y ...:.......... pin g level..in i ft., below .grade s Duration of 100 ldjiT Z AT ..AND OF TZ T: Clear Cloud �.___Y__ 'urbi;d 200 I 0 250 Y Rec.omraended . depth ..of pump .in - well, feet below ,rade______ _:... ...- - WL V lL :.. . i Sand Eff. sizo mm ' HnId. eMef size ®200 L.erigth of.. screen ft. Diam. of screen _............. _....,.._...... Type of screen S- cr`eeri� COM. s,ITTS )x-aw a sketch of the property )n the back of this sheet locating Drilling start,,:;d: -:-C�:mplet; ,-d- �/ I.IE W= AFD S..�WAGE DISPOSAL SYS..` -:PAS i Well Driller (,'/ ( 1AZA, na o.. x Tr \. T,' 7_ 7rrt �..��., -� t+ S =rj }-a FUUNALI COL�TY DE�z_.i.L_.l 0. :.�.�bri .... - �.DIVISIUi� -T. �r'^.rj -E' A,'L` l i <� i DESIGN DATA SHEET - SEPARATE SE, :AGE DIS 0SaL SYST': FILE N0. O�oner ' JM CAI n>i`e3 Address A&' . c=am Sr' Olev it icy y.4G��� ��x ��� Located at (Street).- 5W,91W/I1c/t ©/�:ltL ._ Block _3 _ Lot (Indicate near_est cross s zreet) hlunic.ipali�y Toc�.ti a.�= .oi�Ti�s4�t ��u� ;;atershed�9/Gl7Z SOIL PERCOLATION TEST DAT RFOLIP�,. TO vE SUE':TT-7 D III TH APPLIC_ =.TL Hole -- Number CLOCK TI`IE PE RCOL_ITION PEP.COL -ITICN Run Elaose Dept Lo t :_ter. Water Level No.. Tinte From Ground SL'•r =_ce in Incr es Soil Rate Start . Stop 'Min . Start Stop Drop in Min,/in. drop Inches Inc=eS Inches /7 Ad za /d 3 6,7 3 S 2 q.s-� n7 j� l� 3' . a J.3 - 3. 4 _ 5 l 2 3 4 S� Notes: 1) Tests to be repeated at same depth until approxima tel*, equal soil rates are ob- tained a e ch percolation test hole. all data o be submitted for review. 2) Depth re =_s,�zements to be Trade from top of hole. Name STANLEY J.. - LANDER Address B.a r a PUTS? M COUNTY DEPART, [E\1. OF HEALTH Sail Rate Approved Sq. Ft. /Gal. �o Checked b Date 3.6 '_ c -t .. a.... .i,r :.c..., ..•...... ...,. o�A: .. .:o r .- �:�5. - w+r.rb.; t+-a ....a::.. _ .. r c. ..'. ,-..... y..o ..`.-. �- ' :- :f_'.- - - Nrti.- '_ --• - -u 42'= TEST PIT Da TA P,EOUIRED� .,0 .E SUB-IITTED r','I T -H APPLICATIO\ . DESC.RIPTION OF SOILS ; E`,' C \TEP :ED I`: TEST HOLES 54r= DEPTH HOLE v0. �� .HOLE', \0: �°Z HOLE \0: G.L. 6 0'= /a.-- s d i L 66== . . 6 =r 12 ii 'i2r�cE. GL✓4�iUd . -T/1, r cG�3 -r' lg 78! <� 24" 8 4== . i� i. r. Name STANLEY J.. - LANDER Address B.a r a PUTS? M COUNTY DEPART, [E\1. OF HEALTH Sail Rate Approved Sq. Ft. /Gal. �o Checked b Date 3.6 '_ i 42'= 48 54r= 6 0'= 66== . . ii 7 2:. 78! 8 4== . INDICATE LEVEL AT S'?HICH '.GROU- D WATER IS ENCOUNTERED �/v L•�� ?[� INDICATE LEA L TO WHICH WATER LEVEL RISES AFTER BEI'�G ENCOUNTERED TESTS; '1DE BY �ST.9�/�cT � e105W0do2 Date 3 °moo. -71 llY. S Soil Rate Used Min /l =' Drop S.D. Use -le Area ?r'o-: i e'd S0- oc7 No .' of Bedrooms - Septic Tank Cap _city 90o Gals. Type oWA_sriv .4 ,ey Absorp.tio:� Area Provided 56 =t crid�h trench. Other By 177. L. +�a� �SSe. Name STANLEY J.. - LANDER Address B.a r a PUTS? M COUNTY DEPART, [E\1. OF HEALTH Sail Rate Approved Sq. Ft. /Gal. �o Checked b Date Pp VEI D