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HomeMy WebLinkAbout4480DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -9 BOX 34 I ru .. ,. ' 16 �� �� Y ir - .� 40, kP 't Z PUTNAM COUNTY DEPARTMENT OF HEALTH - 1p\, Division of Environmental Health Services, Carmel, N Y. 10512 Permit CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM /:�Ao py ® ;/1G y Town or Village Located at - ��l_�. TAX Map. 13 Owner a d /�- 41� /`Fo rmerly Tax Map Lot # �` Subd. Lot # ® Separate Sewerage System built by �� 1-16 e / Address Consisting of X41_ al. Septic Tank and 4 rim Z, �t �Yl �-- J�r+�✓I��� -� Other requirements Water Supply: r Public Supply From 00'7i1" !//l l• �''� �r Private Supply Drilled By Address Building Type Has Erosion Control Been Completed? O°9 No, of Bedrooms Date Permit Issued I certify that the system(s) as listed serving the above premises were constructed of which are attached), and in accordance with the standards, rules and regulatio Putnam County Department Of Health. Date Certified by- �y Aad►ess Any person occupying premises served by the above system(s) shall pr ptly take suc conditions resulting from such usage. Approval of the separate sew rage system sha available and the approval of the private water supply shall become n I and v whe subject to ificetion or change when, in the judgment of the fission of H Date i gy Rev. 9 -91 _s `,. *A m,;'on',the plans of the completed work ( copies li ttiI filed plan, and the permit issued by the �F` • ° '� Zy ��: -yam-' License No. luty,to secure the correction of any unsanitary d.as soon as a public' unitary sewer becomes ply becomes available. Such approvals are ification or change is necessary. Tide- —> PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER to PROVIDE PERMIT # ON CERT FICAT 0 PL I CE. ....., Division. of. Environmental. Health Services, Carmel, N. Y. 10512 PERMIT �J Jr CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM p� Town or Village Located atLLL —� —� Tax Map Block J Lot Subdivision < c1 /9d 1 7 subs. Lot # Owner /Address I'Ale C& � / 7 C• "/ Building Type �'' Lot Area , Number of Bedrooms , Design Flow G /P /D 1 * o41 Separate Sewerage System to consist of ✓ aa�0 Gal. Septic Tank To be constructed by 6 YfzE y Rene :j Revision Date Of Previous'Agproval Fill Section only P.C. H. D. Notification Required and 46C, L F ?� / /W/ timed __! Address Water Supply: 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 in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of ConstructioKetwol2lay 1NI11M tisfactory to the Commissioner of Health*ill be submitted to the Department, and a written guarantee will be furnished the owner, his 46rsNst's ssigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the r mediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sy 6 @ to ) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in actor nce , the sta ru send regu a� omens of the Putnam County Depart m nt of Health. ° ) o, Date / Q Signed Gz - m� P.E. R -A. :« Address a License No, APPROVED FOR CONSTRUCTION: Th' approval expires one year from t e date issu n building has been undertaken and is revocable for cause or may be amends r modified when cQQQ sslder necessary by the oP�l tt y cha a ation of construction requires a ,per it. Appr or disposal of domestic Dani�tIry sewa�a�r s ' n. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. or Purchaser of Building Section Block Lot Building Constructed by "0009 Location - Street Municipality Building Type Subdivision Name Subdivision Lot # GUARANTEE 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, is "caused -By� thd-WifilfU'l or -neq:lrgent act--of -the-oc'cqpant­of -the-- building iltiliz ny =' 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 day of 19 Signature ,-�- Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) ess Address rev. 9/85 mk PUTNAM COMM DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT r ! G /I.5✓� __ �� // C� INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION 11 YES NOI CAS Wetlands on /or proximate to property.. Property lines or corners found ................... Can estimate house location........... .......... Willdriveway 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 soil i)escri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft 0 ft.. 3 ft. 6 ft. 9 ft. 12 ft. 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descr DATE: FINAL SITE INSPECTION INSP. YES NO CAS House SSDS located per approved plan ............. Length of trench measured G,C� Width of trench average Slope of tile line and trench cca ptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... .............. 10 ft. maintained frm property line and 20 ft. from house... ........ ............... Distance well to SSDS (ft.) ............... .. Number of bedrooms checks ..................°..... Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally from trench ............... <.................... Boxes properly set.. . ..... ................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area... - Does lot drainage appear OK in area of SDS......, I FINAL GRADNG OF SITE ACCEPTABLE.. ..... ..... XO - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . ,. .... .. , -_.. ... - .. -- .. •- ._.. ..Date 71j& I Re: Property of /�,iSja�r �i �,�,1 A•y. �/�/� , Located at���� (T e Section 120 Block J Lot Subdivision of /V;_,/,6 ;_,/,6 ��n� Subdv.. Lot ## / Filed Map ## e� Date Gentlemen: This letter is to authorize 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 ystem or - sys- t-ems ... in- conformity with "the"provisions"'of`Article" 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, iof A!p o P Signed ­,&" Owne of Property Countersi .4 P.E. , s3'. �S p• VOW ., till v � Address�a.- :•.:,5.,,= Telephone Address Town F Telephone DO W,T -,1ITS MRP L6CAr10rJ 1 Youse plans O.K. D±sign data sheet Peres presoaked? Kin., 30" perc test dept Cont. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individ Authorization for engineer Metter from Water Supply i aDDllcab e If variance requested -such noted on plans & TU-nr. L ticmt TN P en, I-) E11PRL1 !RFR ^•IGNaTURE beAL ON P=-- D.TAIIS I, . FILL DupT11 RR A SRok-W( C`I) PLAN TO ae 9Ro, Existing contours shown (show new contours) Slopes for driveway cuts, etc. shown Rater service line location Footing drain, etc. location Top slope bottom s'o e of fi is Std. i Rnm� nita „I I I Percolation tests and deep test pit location I I Septic tank size and conformance to std. I I 13. R. house tninir,um i I House setback shown I I Distribution box ft below frost I All water within ;Qkt. of. PL shown tJEllgS -CING 12" PIZOVE- GkADC ; Plan and profile SDS ...• 1�� • ...... .....:.. ..... All other wells and SDDS closer 200 shown or reference made ! �. Property boundaries (metes and bounds- clearly shown ) ; LEG:tL 3,�CXIsrll =ta r1N >eov4L j --- — -- - – -. I REALTY So V1 t> IJ ISI WETLAIUb DEC Pelt M I S !SEPARATION DISTANCES SPECIFIED ON PLAN �10' to P.L. , 20", to Foundation ►calls i0o to Nearest well 100' to stream, march, a e, etc. incl:expansion 5' to Curtain drain 451 to to water line (pits -20 5' to storm drain �0''to large trees 0' from i'oundat:ion to scl�tic tan 5' to pipe from leader drain .1'ooLinZ rain. �Z5 To CA-M4 6Rsl" l5l WELL TLS 0 501 -ep-nC -rAmv c0 • wEL.1_ �iC h ,ii,T,n MINX hl'ST. '1 • Dite : Insp.by:_ INITIAL SITE IiISPECTIOT, Z Y Y.es N No C Comments Property lines or corn•rs found . . . . . . . _ _ Can estimate house. location . . . . . . . . Will. drivcway need cut - - Must trees be removed -hote these _ _ Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . ' Sufficient SDS area available considering ' driveway cut, houze location, separation . distances, etc. . . Djy, weLl3/sEPT,CS DERP HOLE EATA Dapth: Water elevation:. Rock elevation: - Soils d.escr`LDtion: ! s s House located where - shown on approved plan SAS located where approved . . . . . . _ _ 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 N0. •3 owner r %�,�,�y� Address Located at ( Street J II 1135-11 Sec. / 2,cP Block Lot Indicate neares cross street) Municipality �/ c 'r l�' /� 'Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse No. Time Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches water ve in Inches Drop in Inches Soil Rate Min. /in drop �-; 2 %off' 4 3 r, 5 VP F Notes: 1) T6:�ts 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. 3. 4 3 r, 5 VP F Notes: 1) T6:�ts 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. ?UiNAM COUNTY DEPARTMENT OPWLTH •ivis! -n of Ern.-4;—Iov,,-,t!_1!C,11- S,2rviccs FOR PER& PUTNA? ,P) : commission - of V-0 Lah WPIRATF, OyjjjPjQCA1DnN T APPLICATION SUBMITTED TO COUNTY HEALTH DEPARTMENT in Lac mallar ON; ;on for • represent Rv corippritioa and am auLhorized t� 1CQ fur 0. po Uzi V S officc at pr "Fe: A d e and Address) N ZhyL I an ar� will s K� vidnally resp)nsible for any an i all acts of the. corporation with . reSpeL tr V a:proval Eequested and all s . ubsequent acts ralating C' ?t0. S w u --n to befare me this da.- k o Title: "Lf NoLary Pub! G � 4 MILL PONDS WATER COMPANY RD #3 Box 29 Mill Ponds Putnam Valley, NY 10579 October 22, 1985 Putnam County Department of Health Carmel, NY Gentlemen; We certify that the Mill Ponds Water Company has sufficient water to supply Lots No' os. 36 and 1 in the Mill Ponds Water Company. Thank you. Yours truly, _ _..._. -__.. _._._._ .-�, . _..� ..�- ...-�. - - .,, _.. _ .,. �, a-- -•- - - -- • -d a - - -- . _--_ _ .. _ __.. �. - � .....�:..� - .., _.. _ .._ MILL PONDS WATER COMPANY } r. Joseph Marinelli JM; im 1 K.7"1 ,� k' eel Y a etk X> MAMMA, ��.w+Mn d� a., V }t 4 ,d w¢" d 1 rwn a t s 2 th Maley r rn Lr c My- t fit' N y r 8 Af A ` s av _ r p 5 't Yr v °',� '} n a ? r t r fiti� W eN y r ,+ a,1 Y Y y S.. `} ,vf' r,+ `r P x Ptr IYS.i i =. r °� 'jt� hY o; -y; Uln Leh K• t r (� v 'rt n� x a ? 4r n. 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