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Home My WebLink About4477DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -6 BOX 34 04477 I•"6 . ;, r ` I ' 9.1 � '1 In � ' R. J� 1 IN I �.� T s, . . . � , I, . "I IN r 04477 dL ENGINEER MUST PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE Division of Environmental Health Services, Carmel, N. Y. 10512 PERM IT # ACE IFICATE OF CONSTRUCTION .COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM %� J Town or Village Located at G Tax Map /O7 Block Owner /�® � ~ e �_f /� Formerly Tax Map Lot R�� J7 Subd. Iot�N7 37 Separate Sewerage System built by �! )4—.* ell" Address Consisting of Gal. Septic Tank and' Other requirements Water Supply: _,Ae Public Supply From Private Supply Drilled By Address ./� i G Building Type ry No, of Bedrooms Date Permit Issued e4le -k/ �l J Has Erosion Control Been Completed? Has garbage grinder been installed? 6pa°ss°o�cnuar . I certify that the system(s) as listed serving the above premises were constructed essen �a %.Eftn on /Ve% plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, i OrbiaQ�c�� 'the re plan, and the permit issued by the Putnam County Department Of Health, c a oc ° Date / rtified by Address X t •' §1. ` C License No. L y�ss 3 Any person occupying premises served by t above system(s) shall promptly take such act," 4W1py rfbaisia5y`�s�Iwgure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall beco I}jJi''tuld :►IONd' s s(a'fl as a public sanitary sower becomes available and the approval of the private water supply shall become null and void when a publ+" ma available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, fijch edification or change Is necessary. Date 41L\11 " " By Q Title Rev. 6/85 CONSTR TION PERMI Located at Subdivision owner /Address PUTNAM COUNTY DEPARTMENT OF HEALTH Permit a Allz Division of Frivironmental Health Services, Carmel, N. Y. 10512 FOR SEWAGE DISPOSAL SYSTEM�� (ri /1✓� rrr° � 1 own or mage ro/ / Tax Map / Block --�r Lot Renewal _ O Revision _0 1 j, Oi`f.� Z!L0A'Date Of Previous Approval / 71 % a Building Type J1G- =11 Lot Area _� Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D / a dG P.C. H. D. Notification Required Separate Sewerage System to consist of Gal. Septic Tank and 4i V � 0-51 To be constructed by �j Address Water Supply: i Public Supply From Private Supply to be drilled by Address Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and•, intdccordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of'_Cbhstiuc ' e" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the`:awn P s �jh or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system durirfg i d I Immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the origin sgsi�ni'�yi� to; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in a drd ith the bird rules and regu a tions of the Putnam County Department of Health. Date Signed f "4� P.E. R.A. C a .� #` Address License No. APPROVED FOR CONSTRUCTION: Thi approval expires one year from t6e date itsµe8 s s6u r� . the building has been undertaken and is revocable for cause or may be amended modified when c ere necessary by the ifoneF ottA Any change or alteration of construction requires a new permit. Appr d f disposal of dourest Sa i y age antl /or a :iy ;•,w$tuphly. a` Date �� --�r� By -• Title.. PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES M� 'r 37 er or Purchaser of Building Section Block Lot Building Constructed by Location - Street 4eiv Ile Municipality - GYM% !� Building Type i /Y% /�� Subdivision Name 37 Subdivision Lot # 'GUARA= OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee 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 approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made: by -me- to- such. system, except where- the- failure to operate -properly. 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 negligent act of the occupant of the building utilizing the system. Dated this _/4:� day of 19AP", General Contractor (Owner) - Signature Corporation Name �. pr. �, r Address , Vi iv 3 9 r: rev. 9/85 PUTNAM rOU11TY mk I pEPL OF HEALTH Signature V�� Title Co /riaation NaSm`e0 (if fCCorpp.. ) Address PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF INDIVIDUAL WATER SUPPLY SUBSURFACE SEW V/ .1 FIELD INSPECTION REPORT (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ........................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed...... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ HEALTH SERVICES D.H. 1 Lot _ Depth to G. W. _ Depth to rock Soil Descra. tion 0 ft. 3 ft. 6 ft. 9 ft. 12..ft. . I D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. 5011 r— DATE: INSP. BY: COPT'S D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12. ft.: boll DeScrl DATE: FINAL SITE INSPECTION INSP.BY: C YES NO COMMENTS House SSDS located per approved 1 ...::......... Length of trench measured CV Width of trench average — ' 7 61 Slope of tile line and trench acceptable......... Roam allowed for expansion trenches .............. Dver 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. fran house ... .......................... Distance well to SSDS (ft.) ...................... Number of bedrooms checks ..................... atones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ L5 ft. of peripheral soil horizontally from trench ..... ............................... 3oxes properly set.. ... ........... ........ _ould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... )oes lot drainage appear OK in area of SDS....... FINAL GRADING OF SITE ACCEPTABLE �� .5 7 �`vy , �G' i �� -e UZ-- er ; low I PUTNAM CaURM DEPAR'T'MENT OF HEALTH - DIVISION OF EHVIRO HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPEC'T'ION REPORT - DATE: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ........................ Must trees be removed - note these ..... .......... Deep holes representative of entire SDS area...... Additional deep holes needed..... ... ..... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft Soil r- 0 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descr t- 0 ft. 3 ft. 6 f t. 9 ft. Soil Descr 7— DATE: - FINAL SITE INSPECTION INSP.BY: rek YES NO House SSDS located per approved plan ............. ' Length of trench measured C__ Width of trench average ' Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ........ / 10 ft. maintained fran property line and 20 ft. fran house .............................. - 2a Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ ✓ f` 15 ft. of peripheral soil horizontally from trench .................................... ✓ Boxes properly set.. . .... .......... ......... `f Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. .. I / /Anna ;flel o - L.ai �V f = -,��A4�L C)el PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of A i Date Located at G1^r C#j 9-(q V,e' (T) v�vrcttn ViJkt Section '1,0 Block S� Lot Subdivision of o Subdv. Lot # `� Filed Map A Date Q Gentlemen: This letter is to authorize � V-SA � F- 4& U � i , ' 'r,4 a duly licensed professional engineer or registered architect (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 promulagated by the Commissioner of the Putnam-County Department of Health, 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 ?.rticle i4j or Y. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi rye A Pact g= P.E. , R:.•A =a° ,:. g�ei Address UNMI W Y / Telephone U Very truly yours, Signed ,, Owner of Property Address Town I& 159 (k% Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY - OFFICE, BUI-IDING,,.CARMEL; - N Y,:.: -. 1051 DESIGN DATA ` aSHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner l ^�,e Address i Located at (Street C,re'ev L rw Sec. )_20 Block _5' Lot' -3 .�lndica e.neares cross s treet) Municipality 01'ryl V0 � Watershed SOIL. PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED .WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION. Run Elapse Depth to water— a er ve No. Time From, Ground. Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop - Inches Inches Inches. .4 4 5 1 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED.TO BE SUBMITTED. WITH APPLICATION - DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' DEPTH ITOLZ;N0. HOLE - T:H OLE ' NO - , G.L.t ;T 12" 1811 .2411 3011 36" 4211. 48n 54" 60" 66" 7211 78" 81" _ INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE _ LEVEL,.TO WHICH WATER_, LEVEL RISES :AFTER BEING ,ENCOUNTERED . 77:- .TESTS._MADE,BY Late DESIGN Soil Rate Used '2� Min/1 "Drop: S. D. Usable Area Provided 0 No. of Bedrooms Septic Tank Capacity t90 Gals. Type ,. Absorption Area Provided Bye L.F.x24" width trench. � �„ ®i,� � 1 tf ✓�i - � Other Address' 6 � Signature , 7 -7 - THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil.Rate Approved Sq. Ft /Gal. Checked by Date N 561 N Putnam County Department of Health Division of EnviroDml!ntal Health Services; d for conformance with 72- .r3 77' 3f4 ' 471 r J-3 J- r4 't3 6;3. 7S o 4- 4 0 ew Putnam County Department of Health Division of EnviroDml!ntal Health Services; d for conformance with l soe'a /,,v .. h i i �znam a:nzui� �ie�aa•�en�t ®T IDleeil tii. �. '/'Division of F:nvircnmun'ta' l _Health � c Ap4ro - 1 cr co^3orma=5 with s? T x7ations oS the er,ature t tl � F WAr, Ala 7&..s .51 7 < 7: i�