Loading...
HomeMy WebLinkAbout4469DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -26 BOX 34 !7- ic, 1_6 If�' 1 I - �� 'y� - , , 0 6 PUTNAM COUNTY DEPARTMENT OF HEALTH C Division of Environmental Heaft Se idbes, Carmel, N. Y. 10512 Permit a v CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEMj�j� ,Town orv.(ilag Located at j a_ �% / r ° 4 TaX Map ��j Block Owner F ' Tax Map Lot H G Subd. L*t.# Separate Sewerage System built by Alf J Address / -1-14 01rd "A.57 Consisting of -' Gal. Septic Tank and s `� Other requirements yf Water Supply: Public Supply From �1 7-2' Private Supply Drilled .By Address Building Type No. of Bedrooms Date Permit Issued '/oAr Has Erosion Control Been Completed? xs *oneaees of IVEW�yye0 I certify that the system(s) as listed serving the above premises were constructed essentially v elR,''pMy�ea$14 the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accor c+�ln > l�iap•1�nn,,t nd the permit issued by the Putnam County Department Of Health. v' �J"- •� Date Certified by R•A• Address 1 7°pJ°7 or r/s 1� CC'► ytpnse No. Any person occupying premises served by the above system(s) shall promptly take such action as me ry$ tlteti� correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null it Yea• ii j public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public wat (1po� available. Such approvals are subject to modification or change when, in the judgment of the Comml of Health, such revoca ; thiaRl' tion or change Is necessary. Date By Title , Rev. 9 -81 ..._ cn -. ..�_. ......z. ..., ... , ..vww rr � � -.s�.. .-� Y. .,. r_ •, _ _.- ° a., � s, .:.... . -..... .... ... , �, �-� rr �. ,� ..... r. .... ra,• - 0 er or urc aser o Bui ding Building Constructed by Location - Street Building Type 4f `6,f Municipa ity Section 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.bee.n 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- sorrs, 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 caizsed: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 aivironmental Health Se r- _V. c-es of _th4 Putna:m..,COu. -lt D.e artm: r o.f "Heai th'. -.as- ta• whe bhe:r 6> -:riot the w: y p. failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this _ day ofc! .Y.� 19 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 IT p N FYI Sco /c i,..SO.0 Putnam County Department of HealtL Division of Environmental Health b'evioee APProved as n ed for oonformdnbe With /00_ PPlic ble H e and Regulations oS the L'h ! Putn Coun H alth De ant., gnature itle Date - OF NfW t /00� 9��ERp96•�' �! rl a� /GrJ�. •• "Za;x • ai• 0 248S S / �� - �G ,YES•' �� r ��hF�ss10T� *` • GALLON SEPTIC TANK �-s LF x / � ABS. TRENCH RECEIVED '_ JULy2 91982 ry PLITNA(N COUNTY DEPT, i:F HEALTH /,�'diooiT r�cc t - AS CONSTRUCTED '., V `+ SEPARATE SEWAGE DISPOSAL SYSTEM ^7 - CJ cs TOWN OF COUNTY. NEW YORK 'Y DATE ,73 B2 SCALE /f..J_ Nn I J09' NO. BO d ➢ Jos c h F SULLIVAN CONSULTING EN INEERS ` GiApN.p�AIE o/� w U1SprI1d .NEW YORK_ ^ `E. t4 a , „aft -•3. s. PUTNAM COUNTY DEPARTMENT OF HEALTH p V F/ Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM _<Locate Subdiv Owner own or . Village y � .'CL 7a.'—Ma - i _ Blocec Lot Job Address Building Type SJr,4, iCrZ Lot Area 216 Number of Bedrooms � Design Flow ) � Total Habitable Space �” Square Feet Separate Sewerage System to consist of //1�0 Gal. Septic Tank and To be constructed by v rY " Address Water Supply: P Public Supply From��� i:� %r✓i� ��7jt. /� Private Supply to be drilled by Address Other Requirements 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the sel above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to3tti be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the place in good operating condition any part of said sewage disposal system during the period of two (2) Years imme�l$tely� ante of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) thato h will be located as shown on the approved plan and that said well will be installed in accordance with the standa 1511 I r'ules;agd.`i County Department of Health. Date Si nedA K ~Y Address APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unles onstr ction of the 6SO1 11 rn revocable for cause or may be amended or modified when considered c scary byte Commi er of Health. Any chats ge requires a new permit. Approved for disposal of domestic wage r privet a n y -- 41 /n < Date By Titl@ e sewage disposal system IU lationslof the Putnam immissioner,of Healthwill Ider- ,.that said`,ouilder will iw ng thed 4,af the issu- illed well;,descr4d above stio� ns of,'',the ,Putnam r� k PE: _ aR.Plt W No. -,� S been ,undertak`en and is RITNAM M'NIT _Dr*,1W'T.--5NT 01- I(rAr,Ti( Date. Re:. Property of d Az Located- -at �G r/ Section 12- Block Lot Gentlemen: This letter is to authorize_ r;rh i"duly licensed professional engineer or registered architect co, (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 promiulagated by the Commissioner of the Putnam County -Department of Health, and to sign all necessary papers on my behalf in C2 connection ­.,it-h this matter and to supervise the construction-of said system or.- systems in conformity 'with the provisions of Article 145 or e .�Law,,.'.:,and,' 147, Education Law, e' � �h, Sanii- Public, H tary Code. Very truly yours, Signed- Mner of Prbperty or Address Telephone -3,5' Telephone 4 PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -105127.., DESIGN DATA SHEET-SEPARATE ,rSEWAGE DISPOSAL SYSTEM FILE �NO. Owner ��;/�,�� ��'�`� L��°�T [.�� Address / // J 14a: 17 Located at ( Street )/%/, V. , vas / sec. 2. Block Lot 2 7 (Indicate.. neares cross, street) Municipality KirTref.-ki AKO� i Watershed ? ERCOLATION TEST BE SUBMITTED. WITH APPLICATIONS 5 1 2 , 3 .__...__._ __.__._..._........_..__- ....__ _.._......._...._____._ __..._... _.....___._:_ __ ._ _ ....._._._.... . JJ 5 is Notes: 1) Tests to be repeated at same depth until approxi tel equal soil rates are obtained at each percolation test hole. All dalma ed for review. IIKE 2) Depth measurements to be made from top of hole. OCT 2 61981 PUTNAM COUNTY DEPT OF 10A �- . Hole Number.. CLOCK TIME PERCOLATION PERCOLATION` Run Elapse No. Time Start -Stop Min. Depth to Water . From Ground Surface Start Stop Inches ..... Inches Water Level in Inches Soil Rate Drop in Min. /in drop. Inches . ROO 4 5 1 2 , 3 .__...__._ __.__._..._........_..__- ....__ _.._......._...._____._ __..._... _.....___._:_ __ ._ _ ....._._._.... . JJ 5 is Notes: 1) Tests to be repeated at same depth until approxi tel equal soil rates are obtained at each percolation test hole. All dalma ed for review. IIKE 2) Depth measurements to be made from top of hole. OCT 2 61981 PUTNAM COUNTY DEPT OF 10A �- . TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES : '- HOIZ-" 0 iz ' G.L. XZur 6 1211 1811 2411 3011 3611 4211 4811 5411 6011 6611. 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED.. INDICATE LEVEL.TO'WBICH WATER , SES-AFTER BEING-ENC9UNTERE9 TESTS,,-MADE- -13Y DESIGN Soil Rate Usedep--y-, Min/1 "Drop: S.D. Usable Area Provided 0 No. of Bedrooms Septic Tank Capacity lel'e- 4 Gals. Type' Absorption Area --Pr—o-vTff-e-E By_j.� L.F.x2411 k_-7- 36- width trench. Name 40:5 > i 7- y (XIIIIII/ SlgnatFre 7, 77- ��i ,v Address THIS SPACE FOR USE BY HEALTH Soil Rate Approved - sq. Ft/Gal. q ONLY: Checked by ESTABLISH ELEVATION OF HOUSE TL1 PROVIDE DRAINAGE O_F L(�NE�S�'f P13C'i`URE. °- • /'•' TO SEPTIC TANK AND FIELDS,.. ✓.... AREA .RESERVED FOR �F�tVAGED�SPQSAI.- SYSTEM TO REMAIN UNDISTURBED CONSTRUCTION / / / %- ALL• TO, E AND LOCAL STANDARDS AND REGUL'ATIONS'... .... _ Wuf�� / 4�" X. IPutnam }[; county Department of Health �Ivision of Environmental'Health Services /00 4 C Z• -. fx. ���'• �pproved se noted for conformance with l _..._..,..... OPT 2# 1 ��L-p /C /' 20� -c, 1 ; as x applicable rules and Regulations of the jPt1TNA4 CpUN _ ��__p� " - `-- ounty lth.Department. , PAPT _OF?iHEAL i �✓ /rr ignature T tle Date 1 G ' / 2 /6 it' _SiJ� PROPOSED G SEPARATE SEWAGE DISPOSAL � SYSTEMS - TOWN OF DATE .- CY,1. OG UnAI n.Tl(lf.. D11 TG tl ♦AI AI /l AI IAI tea.•. . -. _�_�._ .�...._ 1' S, mac'- -S C/i3. A SULLIVAN ... ,1 i.