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Home My WebLink About3649DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -5 BOX 29 y•, T rr 03649 6,-J g U PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRANMENIAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME !}1t. lhona2 Bacne PHCNE 526 -279' SITE LOCATION 46 Shamnoch DitLve Putnam Va.l.Le�g. NY /0579 TO MAILING ADDRESS 46 Shanmoch Dlti.ve, % utnam VaUeu NY 10579 0 PERSON INTERVIEWED Tom B,%;Oe (Ownenl PCHD Name & Relationship (i.e,'owner,tenant, etc.) DATE Aau 2, 1996 TYPE FACILITY % ai.vate Ann l.linP; Canplaint # W10 PROPOSED INSTALLER A"o -pac Sanitation Septic, Inc. REGISTRATION # 41 217 Kennicut lld. ?d. - Aahopac, NY Pro (include sketch locating all adjacent wells): Nam: Repair must be in same location and of same type as original Different location may require submittal of proposal from licensed registered architect. Proposal approved PHA 6284526 sewage disposal system. professional engineer or la4ta,U (3) lni -Ga ULe4 to ex L4- i.n2 AegiLc Auuatem. (In exnan Lon aaea) *No cloaea to we.U* Inspector's mature & T Proposal Disapproved Promsal amroved with the followinq conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. to c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner,,,dr reported ag t of owner agree to the conditions. SIGNATURE d TITLE DN CP16: V&be (F;ID); YaW (psi HE); Pink G R21aant) /�- /o/ — 94 J 1 Pil c T�K.a Y i9 r 4df 336 1 9` �aa DO 11 a l /Y14y 07 C lea ray r N � i47 OD D ?' N -0 T`( �C.) o mhca) � a _;0, 6o 3 aCD 0 ?Z .0 v a Ocaner or Purchaser of building Municipality' ..�, rq 0. � . x.n: .rs sz .m�.`r.. . , .. . � •: -� /�' .s^a• . v a..w.:®.� cv. -wv oc...:.o-,.t'+ , , Building Constructed by Section Location - Street Building Type 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 t}ie \1s tandards, rules and regulations of the Putnam County .Department of Health, and hereby` guaranty 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 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental 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....negl g Mt. -act of =the occupant of t}�e ,building utili� n .the.. system. - _- - - -- - ___ N _._._ . Dated this day of Oct, 19 ,23 Signature Ti tl J� Aaddre (if corporation, give name and s) 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 Location - Street Block r Building Type 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.. .8�ho�vh on the approved plan or approved amendment thereto, and in accordance with th'e:gs tandard.s, rules and regulations of the.Putnam County Department of Health, and hereby` guaranty 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 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 occupant of the building utilizing tl^ sys ±`m , The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the ,system to operate was - ayse.d. by .the_wit_1 1 or..neglsgent:,ae = ef.. -thy. oceL�.pant of the 'building utiiizi;ig -the''- system.. . Dated. this day of [✓ 19X Signature Title (if corporation, give 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 r , WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEIL, NEW YORK This report is to be completed by well driller and submitted to County Health- Uepattment- together with iaboeatorY report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME r• ^^ ADDRESS OWNER J LOCATION (No. 8 Street) (Town) (Lot Number) OF WELL BUSINESS PROPOSED �� DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF AIR WELL ❑ SUPPLY ❑ INDUSTRIAL ❑CONDITIONING ❑ (specify) O DRILLING COMPRESSED CABLE OTHER EQUIPMENT VN ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION (Specify) CASING LENGTH (leaf) DIAMETER (inches) WEIGHT PER FOOT n THREADED ❑WELDED SHE DOYES OONO YES NG � NO T DETAILS (� YIELD HOURS G.P.M. YIELD (G.P.M.) TEST ❑ BAILED ❑ PUMPED COMPRESSED AIRS^ WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well r� LEVEL T L.: L in feet below Land surface: ?1 V MAKE LENGTH OPEN TO AQUIFER (test) SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: DEPTH FROM LAND SURFACE FORMATION DESCRIPTION FEET to FEET G- D'-2)'C) If yield was tested at different depths during drilling, list below FEET I GALLONS PER MINUTE Diameter of well including gravel pack (inches): Sketch exact location of well with distances, to at least t two permanent landmarks. � A a Y COMPLETED DATE OF REPORT WELL DRILLER (Signature) , Ly a a _ .. .. .c . • -- .. _ .a a t.'. +..r.. v_ .. _ rx .�.s.T' - -.. .... .. �. .• „ g+.�: .t.♦ ^C.e ✓'aS �f.. —i .+ct: :6�aYc � .. n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Oe -n --e Located at _� �,oy� c /( G/ri �- e Section a Block Lot Gentlemen: This letter is to authorize TO -5 ems 1 � 3µ� b�� +✓a h a duly licensed professional engineer V/ or registered architect (IndicaEe-T- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam.County T1....... yJ- .. -..-4- !� TT-. � l 1 L 1 L_ J '1 Lcpal uroliu Of Heap h, and t o sign all necessary papers on my :�etlali in connection with this matter and to supervise the construction of said 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. Countersignec�t + + + +l�at►'A, ^�+ ° �t '4 p4' P.E., R.A _°y °o .. (Seal) Very trul yours, Signed Owner-o Property �� Address / r Property lines or corners found Can estimate house location . . Will driveway need cut . . . . . Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes n °eded. . . . . Sufficient SDS area available considering driveway cut, house location, separation . distances, etc . . . . . . . DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description:_ -- - - - - -- -- Date: to - - a. FINAL SITE INSPECTION Ins p. b House located where shown on approved plan. SnS looa.ted t•rhere a_ppro e !r-;(;211,rf, !:.: I..c�'t- '!':'� 'n'= := 1.`;L.!T•t -'.11, �P�'. t t Width of trench average .Slope of tile line and trench acceptable Room allowed for expansion trenches. ✓ Over 50 ft . from swamp; -fratercovrse :soil .:nod stripped or SDS area unnecessarily graded . . . . 10 Ft maintained from. prop -line. and 20 ft from house . Separation of trench from house, well etc. follows plan . Number of bedrooms checks ✓ Stones, brush, stumps, rubble, etc. greater than 15 ft . from nearest trench 15 Ft. of peripheral soil horizontally from trench . . . Junction boxes prope_,ly set Could surface run off from driveway, roads., ground surface, etc. channel near SDS area � ... .. . Does lot drainage appear O.K. in area of SDS 7 FINAL GRADING OF SITE ACCEPTAHLE ,,*t A* e -eec 4ecA 411m•. REVIEW CHECK SHEET .DOCT.JN FNTS House plans O.K. Design data sheet ! Peres presoaked? Min. 30" perc test depth Const . , results for ,3 runs D. Hole log O.K. Corporate Affidavit for other than individual Authorization for efigineer. Letter from Water Supply if applicable If variance requested-such noted on plans & apps.;. Meets Std. Remarks ! 'Ci ... es o ✓. ,, ✓ ! ✓ ; �. ' I ✓ ! DETAILS if change is proposed,) Existing contours. shown show new contours) Slopes for driveway cuts, etc.. shown Water service line location Footing drain, etc.-location 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 House setback shown . ......,_,1./1..TUi;- i1Juu-Iozi _1Jo.lL.. L U All _water - ..within . JO .ft. -of PL- shown ..... ................_ _.._....._... _ ......._ Plan and profile SDS All other wells and SDS closer 200' shown or re.ferece made Property boundaries (metes and bounds - clearly shown ✓ I ✓ . i 1 � .�......:.. SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. incl.expansion 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 0' from foundation to septic tank i�5' to pipe.from.leader drain & footing drain l ' 6 4 - -_ - PUTNAM COUNTY DEPARTMENT 'OP HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of ZL zt' : GAIs7; �. Located at Section Block . Lot Gentlemen: This letter is to authorize „Jos&~ a duly licensed professional engineer r/ or registered architect (IndicaT-er- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County T1�..-... y t- f He i i i t_ l all ^f Lcyal tuicii� Oi ncd,� mil, aiiU t V sign c1,11 necessary papers On my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or. ,...- - _.---147;. Edu-�Utib ri maw; the r^abli&-He&1 -th =-Iaw; ,rid ^the- 'Putndin- County Sani- tary Code. >2 ?Z 0 3/8 —'Teieptipne l PUTNAM COUNTY DEPARTMENT OF HEALTH BEI RVIO'EPi ... �:_.._ -__ ,.r.:. _ •; .. _ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner.FG 9,,ge 6;As7`. Clo. Address -I-/ ST �(%Gt✓ �/,,,��C „tom �[/ Located at (Street SiL/,9/ o , , Sec. Block Lot indicate nearest cross streeET Municipality. �u7`,y gl” Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 /.' /S &Z-7 Ae 20 Z 2 /: Z7 1.4Z iS 4 5- 2 /.'3S /,5D is Zo 23 3 3 4 _ 5 1 2 3 4 5 Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. , , G TEST PIT DATA REQUIRED TO BE,SU _. DESCRIPTION.OF'SOILS.ENCOU DEPTH HOLE NO. / HOLE NO. G. L. e- 7Z0jg:�650/e- 6" 12" 18" 24" 3011 e TED WITH APPLICATION ED.. ]'N TEST HOLES 2 HOLE NO. 361f 4211 48" 54 60" 66" 7211 78" 8411 70/,v <50 i,:�- -. INDICATE. LEVEL AT WHICH .GROUND WATER IS ENCOUNTERED•. __.. _... _. I•NDICA-M 'i'O - WHICH. WATER LErI :L` RISES ~1 FTER BEING Imi COtflMRED ...•__w. . !PESTS MADE BY y.9A �ttSOo— Date DESIGN Soil Rate Used .S Min/1 "Drop: S.D. Usable Area Provided SOQT No. of Bedrooms _Septic Tank Capacity /0-av Gals. Type C.0 C- Absorption Area Provided By r a _L. F. x24" 36"�h treh. .� Othe Address s ,eG� �� ,ng �gPav °De iQA p� 1 c' cM Y� �"• ° THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: •� Soil Rate Approved Sq. Ft/Gal. Checked by °, °r d'an�``;•° Date