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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
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