HomeMy WebLinkAbout3651DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
74.14 -1 -7
BOX 29
03651
I
IL
F.
cog
1
I III& .
j . "'
,
F.
.r
T
1
6
f
0'
k� m
Ipm
f
I ■
, ;
m
Z
ip
m
03651
Division of Environmental Health Services, Carmel, `N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Located at R✓ r��a / J� , " `
Subdivision �LUE� MO%r'�2�jF --� Z 3
Number of Bedrooms :
To be constructed by
Water Supply:
to consist of
Public.SlInniv Frnm
Private S
.ddress
Other Requirements
Lot Area
a
Gal. Septic Tank
Total Habitable Space &4'r-e V /-6-6 4=) Square Feet
:1
_ lineal feet X¢ width trench
Address Kallej AL Y.
I represent that I am: wholly and complet
above oescribed will-be constructed as
County Department of Health, an
be submitted to the Department, Eb
place in good operating conditi
ance of the approval of the Ce i
will be located as shown on the a T6 d
County Department of Health.
Date �r /
APPROVED FOR CONSTRUCTION:, fib a�x)
revocable for cause or may be amended o if he
requires a new per it. Approved for disp
Date By
the design and location of the proposed system(s); 1) that the separate sewage disposal system
h6amendment there to and in accordance with the standards, rules and regulations of the Putnam
kef Certifica te of Construction Compliance" satisfactory to the Commissioner of Health will
furnished the owner, his successors, heirs or assigns by the builder, that said builder will
al system during the period of two (2) years immediately following the date of the issu-
ce of the original system or any r airs thereto; 2) that the drilled well described above
a installed/in accordancgt with t 1stantlards, rules and regulations of the Putnam
1 d It /rLSi P.E. R.A.
d License No. 14&
A year from the date issued unless construction of the building has been undertaken and is
sidered necessary by the Commissioner of Health. Any change or alteration of construction
.saa4tar4 sewa ater supply only.
- ,r :
Title
Iq
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CEELTIFICATE_. OF'COKISTRUCT -ION—COIMPL-1.•4NICE•-FOR SEyVAGE DISPOSAL °SYSTEM
j 1 / Town or Village
Located at � / A ��Gl�'r C ,8 dock z
Owner !JOS', x/" ! /
)� Lot �o Job /J.
Separate Sewerage System built by ��'�� �jfs%E/!'% �tiG Address A ��!`� �Crc � /(G
Consisting of 124 Gal. Septic Tank
1 lineal Feet X �! width trench
Other requirements
Water Supply: Public Supply From
Private Supply Drilled By
Address ' ^�r
Building Type oms Date Permit Issued
Has Erosion Control Been Completed?
.l n
i
S
I certify that the system(s), as listed serving the above mi a Ily shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rule raft's I�t'�ons, pl�� ed, permit issued b the Putnam County Department of Health.
Date OG 7° �✓i ®O. S'L'1� ®@ �
lif18�� P.E. R.A.
Address �G)l zii7 ,� s /oS� ! 3Z7Z
License No.
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 unsanitary
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
subject to modification or change when, in the judgment of the Co er_nt Health, such revocat' n modification or change is necessary.
i� By �' 1 %F
Date
v` G' Title
t
BACTI✓RIA PER ML (Agar plate count at 35° C)
COLIFORM GROUP (Most probable No' /100m1)
HARDNESS; TOTAL
ppms FE} j
- :•
,.
DETERGENT ppm
NITRATES (as N) ppm
IRON, TOTAL ppm
,
Y }
.K. �« �♦.. .- r . r... • «s♦. r.�.� --•- -. ...... -. � -w .. Zn. a .......♦ �.r s....�.�� n..r -, a •. .... .Y.Y iw -.. ��� ...r �.. -.r r... � .«f. Y.�.�.. � .... -.... r T - ..4. -�..,. �.-... �.: a. � «�.. ... �. _ ._
,�ELh DRILLER' S LOG F ABTiE- 777
Fell 'at
a off': ace �;, �geE' o WD
Owner !- ..: P,O, Ad,d ess �
Dept of well �- D� ameter ��. ie d . s Yeas we s acted.
ft. in, gpm yes or no
Ant. of-.casing above ground_L...Below ground �- Well seal �
packer, cement grou
Draw a well diagram in the space - provided- -below an'd show the depth of
casing, the well seal °; .' Kirfl And' th- 103mess' of formations penetrated, water
bearin form ations, diameter; of-- dri'11 holes��v th' dotted lines and
casings) with solid lines.
WELL DIAGRAM. :,FORMATIONS PENETRATED REMARKS
Diameter. in.:Depth Kind, thickness and ype of well ..
-t-- in., ft. if water. bear Drilling.. method f
Was well dynamite I
...._ ..,...... .. _ _.... ... •.tea
25. _�..;.. .��...�..
-.---PUMPING TESTS
12_40 ra'+ _ _ ._ .... +tr. +�- cr.+r• dG;Y. ; .....Y.. � �
' y Stbtic water }
�.
50 _. level, i ft. ? i
t V Pumping .rate
+ j ?5 pum0p-tng : -level in
+ f
�
ft;, below w rade
Duration ,- of ..
1 100 ;_ t
WATER AT E D OF TEST:
C1ear Cloud y Turbid 1
1 i 150 Recommended depth of pump in
o well, feet below grade
TELLS IN SAND & GRAVEL:
i 200
! Sand Eff. size PM
Unif. 'Coef.
Length of screen ft.
Diam, of screen in.
i 1 .254 Type ..of..- screen +
+ ' Screen openings x
r
+
..0
ONIlUIENTS
Drav a sketch of the.. PP
r° P � -ert
- .._. �
on the back of this sheet . Drliling tasted Completed
locating the well and sewage
di is?osal systems. .__..,,� „< ..�... ..
; �9e1�1��3� -rr er ------ - _---e-
ignature '
1 fi u.
i
05 C1 i Grs �vevyr c wp
Owner or Purchaser of Building Municipality
/qi le-i
Building Constructed by
Location - Street
�ZrS �GtGa �Y�+ r
Building Type
� a
3
Block
Lot
GUARANTY OF SEPARATE SEL,IAGE 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 =off nth ...PIj tnam -- Co un ty.,.D.- epa:r -tment of- - w.hethe ii- ._'ox�— no't._the. _...*-
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the 4sy-em. %f Dated this day of lov� 197 Signatur
Title .!✓yam
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
r`
r
_ .......:.......
6�YU �� . ,:.:
•
0LEJC
PUTNAM COUNTY DEPARTMENT OF HEALTH
T. _ H E� T TH -,_ SFRZ —V r C-
,::=nIVISION_. OF -. ENVIROI�?MENTA _
...DESIGN,-DATA SHEET - SEWAGE , DISPOSAL SYSTEM FILE
NO..
jSEPARATE
Owner�/�'%�. /'��� -F"S Address aV'
Located at (Street)1'L�L /Gt J�i.:.(:%T'.....,�0 B],oc�c .<.:
Lot
(Indic ate ..near.est... : cross ,street)
.
Municipality. /
LfT/`'l�rt ll?;J l/P WatershedGC
SOIL: PERCOLATION TEST-DATA REQUIRED.TO.BE SUBMITTED.WITH'APPLICATION.
Hole
:.:Number. CLOCK TIME `PERCOLATION.
- PERCOLATION
Run
Elapse Depth to Water Water. Level
NO;
'dime. . From Ground Surface in Inches
Soil . Rate
..Start
Stop Min. Start Stop. Drop in,
Mirvin. drop
Inches Inches Inches:
2 .3 :3�
3 ,Sl 1 � ... Jg z
2
o .
L7
1.
2
'.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..
y
L.
J
4c k c ;3
Countersi e
P.E., #
(Se
Telephone
t`les is tE cer6ll that the Sewage \\
—
�tt� r f
oat the
e
A� \
was it gas raverer
Oyer t? a E "I;uL'E1ed _
3i the Tll's ad TOP.,
Ile
\\` '•/ � • f� -�'1/ �G refs `' � ;�-r,� ! ai�� .k � � r� `ro,
. AP c•� < � .. � �'�ro �.`.. ���,��� awl
�m.
,APPROVED.
CV mil
� � � � 971 �. �::�>` �. '✓ G.�n:� .
f � J
4/47 l/f Gam. !iQ
Ui:iY . Qf.t1EALTH.
•ntvlsron ac'
oxvi: •..........� :EAU 1 c P.`!IC!!.�
� f {
7
. �J`.G�Gr.•FrrL � .?•flf�%f �'- Jr7r -%K.• � .