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HomeMy WebLinkAbout4217DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.81 -1 -38 BOX 32 04217 I ' L - ., ., L � �. h ;l. � r IL 04217 PUTNAM COUNTY. DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ,92P, t//I;P A? Town or Village Located at �/1fuT �9 Block Owner _A1 %�!V f!%G ! /i(� �iQ+ -_ Lot f7 — Job Separate Sewerage System built by Address Consisting of /4M22 Gai. Septic Tank Other requirements Water Supply: Public Supply From Private Supply Drilled By /�/ shA Address L'r' ' Building Type r•- �'''� No. of Bedrooms — Date Permit Issued` Has Erosion Control Been Completed? '• _p.�aN.�a.e Q�sOw 000 �vv? p i� P� t,�ne Sgmpleted work (copies of which are I certify that the system as listed serving the above premises were constructed essentially as Count Department of Health. attached), and in actor nce with the standards, rules and regulations, plans filed, and the tie ued by t P y 9 r a• . P.E. R.A. Date Certified by, r ») r m ✓ i '� License No. - Address " shall promptly take such action �¢ry°tp c�r►ure the correction of any unsanitary Any person occupying premises served by the above system( 'b�n9�8 conditions resulting from such usage. Approval of the separate sewehge system shall beconlb�n �v�o,k,P�>.L gsY as a public sanitary sewer becomes omes available. S available and the approval of the private water supply shall become null and v dif '� ication or change is necessary. 'void when a publiCr" �tPi+lY�ouch approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such re 161q, Date � ✓Q i�,t.�!. • �l BY Title r PU'I NAM CO DEPARTMENT:.: OF HEALTH" Division of En vironmenta'I Health Services Carmel lV. Y 1U512 ' NTFiUCT ONPERMIT FOR .SEWAGE DISPOSAL SYSTEM�,,gyy� = Town or Village xu�`p�� �/�U%�J�- �� t ddb/ ted at Sec ion 77 e7 - D .. \ lock 3`G u. lidii,ision L/5%�Ga/'�/�J` %C1CL 5,'�a ,° 'g% p� %af Lot' ob p Owner ' © ®it//51>e i� ���' Atldress ir74= X -a c/Z L a ]) Building -Types %lJ itrTl�L Lot'Brea G Number of Bedrooms / Total Habitable Space fJ�O'� 7°r -` r Square Fet 'separate, Sewerage System - io�,corslst of GaI: Septic .Tank lineal feet X Width: trench :To be constructed by �. Address fi Water Supply Public . Supply. From ' r Private SuPPIY:'to be drilled tiv •. Address �y Other Requireme is b O 1 �t Pj. 3 rI represent thatl� wholly antl completely responsible for, the design and location, of the Proposed system(s)' -li that the separate :sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards,;rules an regula ions o the Putnam County .epartment of Health, and that on completion thereof a "Certificate of Construction Compliance satisfactory to the Commissioner of .Health will tie submitted to the Department, and a •written',guarantee Will be furnished the owner, :his successors h s,+t oisy¢ythe budder, that said;bwltler; will place. m_.good operating condition an g 9 p . y part of said sews a disposal system durin the eriod.of tw �y�sd to y. followingahedate ; of the issu 1. ante of ,;the aapproval of she .Certificate of Constructwn Compliance of. fFie original system' or, any, �Id�e;-drilled: well desci,lbed above will be.lotated as s•'hown on the approved plan and that said well will be installed in. accordant With' agglC }8( �an��lfiegula i� ons of Elie Putnam County Department of Flea th.! a, Date SItEt66'I�, -� Address Ca IRK PLACE LLtei ! NO APPROVED FOR CONSTRUCTION: This approval x is '� e r from the date issued unless 'tt�ucti n of the bu�l�j, has been undertaken an is �,�aLit! cable -for cause or may be amended or modified p LwLpp��hen��11�-DuGn'sjj� g r b the Commission¢Pe d Kej,cjierieh�,ur alteration of construcfion ., e,•f P�riA9,mIZ5I1C biA►YI�� . y y dr,"�`'' .. �� �es new permdp^� Ap`prov�ed for dis nd /orr p /viva e` water 1 01,110 J06 J ,rvrN:iu�y Owner. or Purchaser of building Municipality Building Construct:e.d by °9e�tse A �A. yr Location - Street Building Type o Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM M 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 tle�\ptandards, 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 ` NY he - EiF. M. .� The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services.of the -ttnam County Department of Health 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 ; SVs,tem _ - - - ®Wiff6� Dated this day of 1972 Signature Title We& /�,a (icorporation, give name and address) r ! 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 (. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property Located a Date /7-3 ofy lYeo Zr le e7 e Section afi'�o3-- 3r,,Block 5a�c 0' Gentlemen: Lot 3Z:3 This letter is to authorize To- a duly licensed professional engineer�or registered architect to apply for a Construction Permit se g y PP Y 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 Departu,cl7t of H@aitii, and to sign all 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; Education 'Law, the Public Health-1;6w., and`the Putnam County Sani- tary Code. Very truly yours, r I Signed Owner o;'roperty Countersigne s , ►,,, Address P.E., R.A., # �% �/�� .�`'iti OF Ncwiy.,� .�.��s�- '�`�rG C� •/(� YANCIS IME TIH SULLIVAN- Seal) Teleptione A r%; PLACE P. Z o . � ✓� ��� �' 'P�p• °•�0. 24885 • °��'\•` Telep one ROFFSSIO`�A\". r' rz REVIEW CHECK SHEET 04aw (A Meets Std. Remarks f es No DOCUMENTS House plans'O.K. t Design data sheet I Peres presoaked? I Min. 30" pert test depth Const. results for 3 runs D. Hole log O.K. I Corporate Affidavit for other than individual Authorization for engineer Letter from Water Supply if applicable ! If variance requested -such noted on plans & apps.; 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 �a _. - ,_.... .::.:.DL..�.'.Uj.'_LUU.l _LU1_L ;:ilia;..; � .__ual.O:�i._ ir.OS. ...�.. All water within 50- ft . -of PL shown. - Plan and profile SDS _ All other wells and SDS closer 2001 shown -,or; ,.reference ,made - Property boundaries (metes and bounds - clearly shown ) t SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. .incl. 15' to Curtain drain 10' to water line (pi7ts -201) 15' to storm drain 10' to large trees 10' from foundation to septic tank 5' to pipe from leader drain & foo in€ rm . SULLIVAN-THIEDE CIVIL ENGINEERS - CONSTRUCTION CONSULTANTS OLD STONE BUILDING, CLARK PLACE JOSEPH F. SULLIVAN P. O. BOX 308, MAHOPAC, N. Y. 10541 P.E. MAHOPAc 8.8777 MAHopAc 8-5361 le-rep Av� FRANCIS W. THIEDE M.C.E.,',P.E. i3 ,9 ,7-3 PUTNAM 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. OwnerA.r7 or Ale /a r1 Address ,'d ��r,U p cr y% Located at ( Street )'at,r� -/ Sec,&&AJ Block 5"a -1«F Lot: (Indicate nearer cross streetT Municipality, w, e- y Watershed w/�C SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH.APPLICATIONS 3 4 5 3 4 i 13U /v. 20 3 c 2 3 4 5 Notes: 1) Te'gts 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. 2) Depth measurements to be made from top of hole. 'Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in. Min. /in drop Inches Inches Inches 2 3 4 5 3 4 i 13U /v. 20 3 c 2 3 4 5 Notes: 1) Te'gts 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. 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 18" 2411 30" 36" 42" 48" 5411 60" .. 7211 It" . . 8411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. / HOLE NO. HOLE NO. . I 6� p Ke- INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED /Y °v' G INDICATE "LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY &Ij e Date _� )) $ i- DESIGN Soil Rate Used ) 0 Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 5- Septic Tank Capacity a Gals. Type Absorption nvArea Provided By L. F.x4" jb'— , .,.-',,,,,­,.width trench. . t(c QF Ne ;KLIVAN - THIEDE Address t Box 308 THIS SPACE FOR USE 1Y Soil Rate Approved Sq. Ft /Gal. SEAL E Q ��� ; K " y • v y u ONLY: °n�� °,�. 2489 Checked by ,,�ssi�° o.Date r 4�`' L. W 7. 4yry � � i �, as � �� `'-r --�_� `�_�`�—'��:.. -_ -•- `--��, / � �iT E {fit � , �'��•r' s , .. 4'T /6.YT �J2.. I Fi9jy,�IL Y M �� 'M 71 � „t � •hl � �' (�TYV c'.vcJ � ...� ' ` �4 GS'O /RXB EFF.O 1H �I O •j BELJ ?pOM.S S V � � �" .3EE.o/i+3� i° /T � /J�T.QjBU7' /O.✓ � � ff . _ E'Tro�C.rc DX lU /C9f/LG � � �C� /SOO GAY.. ti P PP OV I` D p y 30 K V � Q• � k _ AUG2, �.'� � �.� f W-4," Y-13 I✓L�F� 3e7�/YJG'it/T G%F i7/�i�sGi/Fj� KIT COUNrr DEPT. OF REAE1R PJ % T z .DIRECTOR; _DIVISION OF V2'h�'- x- CNVIRONMfNTPt HEALTH. SERYIUJ ®4��" t LOTS V 377a4/LOTS t/' {!lo //B FJE[� i / - °." 7, :g��9Q c%o94 BL r.I/_° 03 LoT {/_° 30 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM ��•c!h'GO • ./, /i�QL izJ�t/ Wv z a ? .� - __ _ 4,•T /biYl /60D . ,SEPT /C T�9iU otl r �rt'.� - � 4'J76h/T .b /ST,C /BuT�O,V p0� - •Q� f� sUf TOWN OF I . = �• , $ iZIYw'YP.• COUNTY. NEW.YORK SCALE x f ''✓ �_ J, 3 s _,� _ ` 2 DATE U°' = 3 �3 3f/povt� JOB NO. nra, /SOO GALLON SEPTIC A rS ?c/ oB ti !�. L /c.� O Z4B9S SULLIVAN - THIEDE' .. CONSULTING ENGINEERS MIN .._ - CLARK PLACE _ ' MAIWAC. NE*Y YORK,