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HomeMy WebLinkAbout4479DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -8 BOX 34 04479 ;; MINI I Is 16 ' MM Be rr , IM III . ' V 04479 \,\\60 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 i` b .0 E �o ,_r pry f' �f sum A , 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