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04479
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FICAI* --70F
...AN COUNTY DEPARTMENT OF HEALTH
,.► of Environmental Health Services, Carmel, N. Y. 10512 Permit 41; J1
INSTRUCTION COMPL
LcCiitetf.'et
Owner _✓ —e di" � e !6/1 A f _• 6- , � / _Formerly
Separate Sewerage System
__e..__._. -_c_ _ • - -- »_,_�
built by n" rk— ,c
Consisting of Gal. Septic Tank and
Other requir ments
Water Supply; Public Supply From
Private Supply Drilled By
;AL SYSTEM
Town or Village
Tax Map / Gam' Qr _ __ Block
Tax Map Lot # �/ Surd. Lot #�
Address LL 1
Address
Building Type 'lye`- No, of Bedrooms —,— Date Permit Issued__
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving the above premises were constructed ease
of which are attached), and in accordance with the standards, rules and regulations, in
Putnam County Department Of Health.
Date Z/�z �(d Certified by
Address
Any person occupying premises, served by the above system(s) shall promptly take such act!
conditions resulting from such usage. Approval of the separate sewerage system shatr&
available and the approval of the private water. supply shall become nu l and void when a
subject to modification or change when, In the judgment of the Co rr)ission #tof H9F;
Date By
Rev.. 9 -81-
-
o
of the completed work ( copies
p, and the permit issued by the
P.E. R.A.
Ml&ense No.�
correction of any unsanitary
ublic sanitary sever becomes
uc iliable. Such approvals are
ch re change Is necessary.
r ` Title
�� PJ
PUTNAM COUNTY DEPARTMENT OF HEALTH Permit Il
Division of Environmental Health Services, Carmel, N. Y. 1 12
CONSTRUCTION. PERMIT- FOR;'SEWAGE DISPOSAL SYSTEM. Pte_ /�� v� i �
or Village
/ "// ,�4 r � 2-Cl Block Lot
Located at � � A � Tax Map
Subdivision 1171•
Subd. Lot # r--# 7 ' Renewal _ I] Revision _ ❑
Date Of Previous Approval
Building Type �'%a�t' Lot Area—/ B 9 Fill Section only ❑
Number of Bedrooms Design Flow G /P /D �/ y P.C. H. D. Notification Requireedd /
Separate Sewerage System to consist of Ax_ra Gal. Septic Tank and �OCt 1 b4�YViQt' jr_5
To be constructed by Address
Water Supply: Public Supply From J,�1
Other Requirements
Private Supply to be drilled by
Address
1
I represent that 1 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 in a£portrdWft.gy�th the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Co gctefn &o)i Rka pe" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee will be furnished the it.%meevoraJ";**s or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system du g h jimug t�vp (,)-years immediately following thedate of the issu-
ance of the approval of the Certificate of. Construction Compliance of the or inalas t m or anO Apirs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed i c t ance�w)fh the, ntla�ds, rules and regulations of the Putnam
County Department of Health.
Date igned -- P.E. - R.A.
t �.
. Z IVY
Address 1 - ' w • Li N
APPROVED FOR CONSTRUCTION: Thi pproval expires one year from the da
revocable for cause or may be amended modified when considered necessary by
requires a new permits. Approved for disposal of domesti sanitary Sawa e, ani
Date � 1� _U�CJ By
Rev. 9 -81
ten—
o, o.
n of the building has been undertaken and is
lth. Any change or alteration of construction t
only.
J,
Title
S SAL f M
�\.IIJVUIP,NrZE OF SUBSUP1210E, SFI-.TAC.E DI PC, SYS'
.1 represent that I an wholly and ccw.pletely rtesponsible, :for the loc%atic.-�,
m-aterial, construction a drainage of the sewage disposal systr :.-
s6rving the above des.cribed property, and that it Ahas been constructed as shawn
1*!"a P..Pproved plan or 'approved amendment thereto, and in accordance with
: - tiob
:andzal�isl rul,'�s and re-�qul, s,.:of - th,��. Putqaxc.Coun�.v Derartment -of It
herebv Civarantee to the caner, hi-s sU('I_`C:e:-::.scrS,
-m any part- of said system, constructed by 'ctie which fai-.L.
=,,,parate lfcr rf two years imediately following the Jate of approva.l. of t'
Cate of Construction Compliance" for the sewage disposal stL
-s -a sucb_Fyst , except re the fai.1 ux.'P to Operate rdrope'...
madq -by me. _Rt whe,
rat- the bii i I d-i Y.e
the sy.s.. ..t m.
The undersigned further agrees to accept as conclusive the d_eterminatJL`_.--.
the Director <-,,f' the Division of E,'Ivircjr&ienta_I Hlealth Services of the Putnam COI,"%-
Oaoar',I-Reat. o-F Health as to wi.let-har or not the failure of the sys--tem to ope-rat-,
i
C'CiLu.-al 1,}y the willful or negligent of the occupant of the bu
the syst-_m,
oat.ed this
Y od r t
-J,
PUTNAM COUNTY DEPARhIHNT OF HEALTH
DIVISION OF EWMONMERML HEALTH SMVICES
V,
—Own & or Purchaser of Building
Building Constructed by
Nation - e 044
Street
Rini cipality
Building Type
Section Block Lot
Subdivision Name.
_7
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEKZAGE DISPCGAL SYSTIFN
I represent that I am wholly and completely responsible for the location,
workmanship, material, construct-Lon 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, at-id'regu ations-. of the Putnam County Departirent 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 -Eolla4ing the date of approval. of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
-such system, ��qept where the fai, Uure to operate properly is
_
or neg TI rag caused by the,wili7f t_acl�_6�9�_��E!:I_ the�_bu-Ud_i
the system.
The undersigned further agrees to accept as conclusive the detemination of
the Director of the Division of Envirorir�ntal Health Services of the Putnc'un County
Department of Health �as t--o whether or riot 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 day of Signature
Z Ck
General Cont-tactor (Owner) Signature
6or_*ration Nam (if Corp.)
Address
rev. 9/85
mk
Title
f
, _X
co bration Na m,. Uf Corp.)
Very truly .your` a _
Joseph Marinelli.
JM:fw
-41414-14
d
PUTNAM OOURrY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
DnN' BY: I WI-)
( of Owner) (Street Loca ion)
CUMENTS
Permit kplication
Corporate on
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log }�
Consistent Perc Results (3)
30" Perc Hole
Other
'Iouse Plans - Two sets
f PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions.- volume
�r J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
,F&ting /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion - Area;.shown;gr_avity. flow,.suff _ .size::
_ _ if �irnpers Pit- &-D °Box
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
. No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, rge -Tx-ee;-
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fram Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Oetland (Town /DEC Permit R & D) '
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
... a....... _. __l:r'c-•_,. w. - •+•+w.r. • -a ..,.....- .,r...c •ir, y..; ._ c ... . - •'�:.�.. :.:. .... r � r .. .. -..mac. C. ,�q /l � �i ,.. .., -. 'xf,': ,,,-.' � ..:+� y �,^ ,
Date
Re: Property of G9%�Ir
Located at
(T) /4-o" c Section /Al Block. S"' Lot
Subdivision of // / //� / ��✓�
Subdv. Lot # ,� Filed Map # Date
Gentlemen:
This letter is , to authorize
a duly licensed professi.onal engineer — r 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
sy.ptem - -or systems -in ;conformity- with -the, provksioms of Article 145'•R 7 -
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersig
P.E. , R.
Addre s s
G:
Very truly yours,
i
Signed °
Owner of Property
/�
Telephone
/ / i 1// p� ?G e'�
Address /�V� ///
Town
Telephoned "�:�
OF IntAl-
9
Al. .•• L��y1 `..�$�iN4.1.o Yna•.� :: I�wA .sit 4..i��
_QrTjF-T94TGh_.
DESIGN-DATA S1=-S(JBSUFACE,SEKAM'DISPOSAL SYSTEK FILE NO.
Oiner-
Located at (Street) Sec. Block j I.Ot
-(:indicate nearest cross'"street).,
municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking
Date of Percolation Test
HOLE
NUMBER C= TIME
PERCOLATION
PERCOLATION
Run Elapse.
Depth to Water Fran
Water Level-
No. Time
Ground
Surface
In Inches
Soil Rate
Start-Stop Min.
Start
stop
Drop In
Min/In Drop
Inches
Inches
Inches
i zze'& 1'ze'l
1>1
Z
>
4
5
2 211-601
4
2
L=�k;20 L
3
4,
5 -pu-rNAm r,,OUNTY
QE HEALTH,
NOM: 1. Tests to be repeated'at same depth until approximately equal soil rates
are obtained at - each percolation test hole. All data to'be suh4ttod
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REOU31M . TO- BE
DEPTH HOLE NO. % HOLE NO. HOLE NO. -
2'
31
4'
13'
14', _
INDICATE. -LE 7E1., AT WHIQi -,.g.�€' tOUNMTIER -.1S ENCOUNTERED _...
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE .OBSERVATIONS MADE BY: () c ti$ 0 �6'�% DATE: /?iL.>
A T
DESIGN
Soil Rate Used (% Min /1" Drop: S.D. Usable Area Provided
No. of Bedroans Septic Tank Capacity gals. Type,, ,r 7
Absorption Area Provided By � L.F. x 24" width trench
Other
l �j" �a°ma••°p °�.
��� _eo •e e_ fO..4dw
Name C
Address
'-sul
Iliv,
vLu
THIS SPACE FIOR USE
Soil Rate Approved
HEALTH DEPAR73�',NT ONLY:
•
s.•
sq.ft /gal. Checked by Date
• X
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sum
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4 MV07
Arc
"This- is to certify that the sewage dim poeal system was
constructed as indicated on this plan and that the system
was inspected by me before it was covered over. The
system was constructed in accordance with all standard
rules and regulations of the Putnam County Department of
,Ueglth and the New York State Department of Health,"
Putnam County Department of Health
Division /En l Health Services
APProyed no a
for ooeormance with
aPP Soable. � e and„gegulatloaa_of..tho�, •�a -,. • _ -. •��;
alih Deyart'ent:
dnature @ I ba
�S �n..sr���e c� �e• -goy � ���os ��y >i�
IF
SO
7
as
37
ii
#4
"This- is to certify that the sewage dim poeal system was
constructed as indicated on this plan and that the system
was inspected by me before it was covered over. The
system was constructed in accordance with all standard
rules and regulations of the Putnam County Department of
,Ueglth and the New York State Department of Health,"
Putnam County Department of Health
Division /En l Health Services
APProyed no a
for ooeormance with
aPP Soable. � e and„gegulatloaa_of..tho�, •�a -,. • _ -. •��;
alih Deyart'ent:
dnature @ I ba
�S �n..sr���e c� �e• -goy � ���os ��y >i�
IF