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HomeMy WebLinkAbout4495DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -29 BOX 34 04495 r me Jr lye f I L t . J. �, 1 "'.1 04495 Building Type / Lot Area Number of Bedrooms - ed Design Flow G /P /D ee Separate Sewerage System to consist of J ? Gal. Septic Tank To be constructed by Water Supply: �� Public Supply From �G'i7 Private Supply to be drilled by Address - Other Requirements Date Of Previous Approval Fill Section Only ❑_ P.C. H. D. Notification Required and Address 1 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 an regu gage o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2, rs Immediately following the date of the issu- ance of the approval of the Certificate of. Construction Compliance of the original-system or a�n� t� that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance wit of �.st da r Us and regulations of the Putnam County Department of Health. z�' ,•/` o rdv P�f � e ° . R.A. Date P..E [ a / r " o i ense No 2—Y Address - APPROVED FOR CONSTRUCTION: This approval expires one revocable for cause or may be amended or modified when consi requires a new perm Ap o, for disposal of domestic. Date BY Rev. 9 -81 3'ib�S from the date Issued tFjlessi constr00t(ort� T the iecessary by the Com �, i_'b : Any .4- ge,tand/ r P s, u1!}ply only o eeeo '4A4e eggs➢ }Bee uild�g has been undertaken and is �AA Iteration of construction tM1 i PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N Y. 10512 Permit # CERTIFICATE. -OF CONSTRUCTION .COMPLIANCE. FOR SEWAGE DI 71. - ----- . Located at Owner Oi.t°P -// : r%� , !" / �. %: Formerly Separate Sewerage System built by >POSAL SYSTEM..,r.? Tax Map Block Tax Map Lot # -.� �. Subd. Lot # 3. Addressi. ✓� ✓r �' / Y e A Consisting of J a Gal. Septic Tank and 4- �`' 11. �� A -f Other requirements Water Supply: �Public Supply From 4C;,.: Private Supply Drilled By Address �ti =5 �TI.s :I� 1., x Building Type No, of Bedrooms `'� Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department Of Health. Date �� �' �' "'� Certified by Address Any person occupying premises served by thelibove system(s) shall pro mptlytlks,;XucRa< conditions resulting from such usage. Approval of the separate sewerage syst6msfgtol available and the approval of the private water supply shall become null and 10610 whelfC. subject to modification or change hen, in the judgment of the ssi/o/ner' f�,•Hee •. Date ��..JJ � By a•+.�`.7 AV. 9 -81 shown on the plans of the completed work ( copies ,with the filed plan, and the permit issued by the oI.z ✓�"--"" P.E. ✓ R.A. s License No.— icessary to secure the correction of any unsanitary void as soon as a public sanitary sewer becomes F ply becomes available. Such approvals are ,. Modlfication or change Is ecessary. Title PUTNAM COUNTY DEPARTMENT OF HEALTH Permit # ''. Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM down or Village at ` `!? tY"a� .� .. J•'�jr3�'S ± - -: - - TB SC'map y v� 121 1: _B1o6k- { 2 Lo ��✓� Subd. t q Renewal _❑ Revision _❑ Subdivision / Subdivision Building Type / Lot Area Number of Bedrooms - ed Design Flow G /P /D ee Separate Sewerage System to consist of J ? Gal. Septic Tank To be constructed by Water Supply: �� Public Supply From �G'i7 Private Supply to be drilled by Address - Other Requirements Date Of Previous Approval Fill Section Only ❑_ P.C. H. D. Notification Required and Address 1 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 an regu gage o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2, rs Immediately following the date of the issu- ance of the approval of the Certificate of. Construction Compliance of the original-system or a�n� t� that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance wit of �.st da r Us and regulations of the Putnam County Department of Health. z�' ,•/` o rdv P�f � e ° . R.A. Date P..E [ a / r " o i ense No 2—Y Address - APPROVED FOR CONSTRUCTION: This approval expires one revocable for cause or may be amended or modified when consi requires a new perm Ap o, for disposal of domestic. Date BY Rev. 9 -81 3'ib�S from the date Issued tFjlessi constr00t(ort� T the iecessary by the Com �, i_'b : Any .4- ge,tand/ r P s, u1!}ply only o eeeo '4A4e eggs➢ }Bee uild�g has been undertaken and is �AA Iteration of construction tM1 i PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N Y. 10512 Permit # CERTIFICATE. -OF CONSTRUCTION .COMPLIANCE. FOR SEWAGE DI 71. - ----- . Located at Owner Oi.t°P -// : r%� , !" / �. %: Formerly Separate Sewerage System built by >POSAL SYSTEM..,r.? Tax Map Block Tax Map Lot # -.� �. Subd. Lot # 3. Addressi. ✓� ✓r �' / Y e A Consisting of J a Gal. Septic Tank and 4- �`' 11. �� A -f Other requirements Water Supply: �Public Supply From 4C;,.: Private Supply Drilled By Address �ti =5 �TI.s :I� 1., x Building Type No, of Bedrooms `'� Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department Of Health. Date �� �' �' "'� Certified by Address Any person occupying premises served by thelibove system(s) shall pro mptlytlks,;XucRa< conditions resulting from such usage. Approval of the separate sewerage syst6msfgtol available and the approval of the private water supply shall become null and 10610 whelfC. subject to modification or change hen, in the judgment of the ssi/o/ner' f�,•Hee •. Date ��..JJ � By a•+.�`.7 AV. 9 -81 shown on the plans of the completed work ( copies ,with the filed plan, and the permit issued by the oI.z ✓�"--"" P.E. ✓ R.A. s License No.— icessary to secure the correction of any unsanitary void as soon as a public sanitary sewer becomes F ply becomes available. Such approvals are ,. Modlfication or change Is ecessary. Title Owng or Purchaser o Building Section ..Bu�ildng Constructe.d.:�y Block .. -,. • _..v. .fit. -- - .•'-. -. .._ - .. .... ..•. .. .. .�.n ` ". �'r is :.. •tt = -: Location - Street Lot Municipality Subdivision Name � 5r Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 initial use of the sewage disposal system, or any repairs made by me to.such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services , .. - - -:. of '"th'e' "Futr a`nr Corxnnty= Depa tm?ent of - Health .a.s- to-- whether. or ure of the system to operate was caused by the willful or rie$lgent'ac of the occupant of the building utilizing the system. Dated this '" day of J J�%!,--- 19Y4- Signature Title -,, - _ A Corporation Name~ (if corp.) Address - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health PUTNAN CC'.1'NIT r)I :I ; j',—II 1T nr itrAi,T11 Date _/ 7-1 `0 Re: Property of Located at Section / Block Lot 5 Gentlemen: J�� •� j 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 - system or systems in conformity with the provisions of Article 145 or 147, Educaton,:Law, the ,Public H alti� Law; .and the 'Putnam ~County Sani- - tary Code. Very truly yours, 4 Signed to' Ow her of Property Countersigned: �'°°° #� Al 1; bns,° � address Telephone Address F J1 f 1 WZ �`tiv AW T cpi►one P',', y 0 x AiY, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE, BUILDING, `CARMEL� yN:" Y T0512 ` DESIGN.DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM / FILE NO. Owner Ao /% Address e. Located at (Street ' -eZec. ,';L2 Block Lot - indicate nearest--cross street) Municipality �! y e'V Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3i> » -. 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. C Hole Number CLOCK TIME PERCOLATION PERCOLATION RLM Elapse 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 1 2 3 32Z f 97,,i -� 4 3i> » -. 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. C TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOTLS ENCOUNTERED I�V,. TE T; HOLES DEPTH HOLE NO. j HOLE NO. 2- HOLE NO. G.L. 611 1211 1811 2411 3011 3611 421t 4811 5411 6011 6611 7211 7811 8411 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED -LEVEL,-RTSEi-S ",-AFTE.R',BEING--E.NCOUNTE TESTS MADE BY Date DESIGN Soil Rate Used 67 ­�' Min,/1 "Drop : S.D. Usable Area Provided—. !!!r_a No. of Bedroo eptic Tank Capacity Gals. Type &_eLe_ _' ) L. F. x24 width trench. Absorption Are. Provided Other Address r THIS SPACE'FOR USE BY Soil Rate Approved Sq. 906060. -4-n&gnature CheckedLbte AJM� F, -� ­ F� ` f L OWN w i TG } pup tip: njfx� WAY � r M F y r.l r afrn�ac��, k i Avon We , 4 � L 4 �4fiL y k 1• j ^ i `� 1 E�.i dr Zt 3 �' � �A '. s yy •s s '� ' ��.v m a �;� WK, a:,q�rhP fitx i a ,P r ME _10 IRA OA .. S,,I',�� ✓lam .�.- GJ.r'.i .. - _ , 1'Ut-nam COUrty Department of Health 31 V161 On Of = ;1711': ".G. a . Health Seralce. R ECE e F! with 9 . ' of the 0-W I JY _ , / DEPT, QF `J COl . VV �''�A�e�CS5S4rp� `�•• i K . r wal e „s M _Ile rylic- el �f I 11% . /.'C 6210-1 4 e-rj -- Ao f a, d o Bppi' Se a'r-v v m /SCS��C/?Gt �YF S Al�i ,, ✓e G,f-� / c".-S 7-e /i'!J ,L- GGY�r C` - '�l'"c? l�!'GGe's) •'-I� �i�.'.7 � -a: / isutfiam County Department of 'Health Division of Environmental Health Service; Approved as -. for conformance with AUG 1 1983 is ' 3 Regulations of the Pu co .:z: calth De t. i'`f ? �•'Ai:? 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