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Home My WebLink About4500DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -34 BOX 34 04500 .1. rr i ;i or ti 0' is r ,. w ., 1 . ,., I Mimi �� ; .r ` 04500 t -✓ °'� e 3 ' ; a ' �'" ,, a Y 7 W"n7 xr 4 j • " PUTNAM COUNTY DEPARTMENT h OF HEALTH E'° } L?ivision. of Eniiironmenal Healfh Services Carmel N: Y 10512 J CERTIEICATE,YOF CONSTRUCTION COAIIPLTAAd_ i=0R SEWAGE Ci SPGSI. L Vt EM l-lid "!� Town or Ilage r . ` V, •: Located at Section ! al� Block c Owner b Lot Jo- Separate,_Sewerage System uilt by - Address b Q' .o Consistm9 of. %�% Gaf. Septic Tank J�� hne'al Feet:X - - -- w.idth trench ..._ £' ;Other requirements:" " Aw- 5 Watert 5upply PUbhC Supply From / Private Supply:•Dr:lled'By Building Type No, of Bedrooms Date Permit Issued r s Has Erosion Control Been Completed `3 'rcert,fy ,that the system(s)'as I,stedaervmgrthe above premises were constructed essentially as o ipaajen °completed work (copies of which are r; attached), and in accordance with .the standards rules and.'regulations plans;, filed Arid th r )Sb dh� ,}}utnam County Department of Health q M .' � r I Date " U Certified by 3 Address License No; / r Any person occupying premises served by the above system'(s) shall promptly take such a qas m `sbe n _ sarM,°t�5�iure the i orrect:on of any unsanitary conditions resulting fromsuch -usage Approva;f,of. the'- separate sewerage,;sysiemshall b *,P r,�,; • g}i as'a public• sanitary sewer becomes " available and the- approyal_of the.,pr)aterwater,`supply shall become null and void when a >�i �N�jy�a4y" �y, IComes available ':Such approvals are a aubJect' tb modification or change when . <in the'r)udgMenV of the,Comm,ssioner of- Health rf,cat:on or,, change' is 'necessary;" z z Date p — r By �.J�tM~ 'Title ' �. PUTNAM COUNTY DEPARTMENT.. OF HEALTH - Division of Eq!!r rimental Health Services, Carmel; N. Y. 10512 )INSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or illage , icated at i / '' C' Lf c%• - Tax Map Block Ibdivision Jeel /° � Lot Z� { Job i Z .vner i L° i? C. Address i jj J C, 'e- jilding Type // Lot. Area /� tv umber of Bedrooms .. Design Flow Total Habitable Space �"3� C> '?v Square Feet sparate Sewerage System to consist of Gal., Septic Tank and X77® A."+ � / o be constructed by W A-4 AcLdress Eater Supply: All Public Supply From Private Supply to be drilled by Address Ither Requirements represent that I am wholly and completely responsible for the design and location of the proposed' system Fi)pFnai�Rpe rate sewage disposal system i ibove described will be constructed as shown on the approved amendment there to and in accordance with ndi 9`i ryAles gu a tons of e u nam j :ounty Department of Health, and that on completion thereof a "Certificate of Construction Compli �� mmissioner of Healthwill i ie submitted to the Department, 'and a written .guarantee will be furnished the owner, his successor heiy4 r signs b 49A& bui er, that said builder will Nace in good operating.. condition any part of said sewage disposal system during the period oft A(2� rs i diatA ,i t ng the date of the issu- nce of the approval of the Certificate of Construction 'Com'pliance: of the original,system or any pa at t ill well described above i krill be located as shown on the approved plan and that said well'wiil be installed in accordance with t rEard d is w ns of t,he Putnam : ounty Depart ent of He Ith. , �: ` i �' y /� '.P a �h J� )ate / 7 (9 (0 Signed • A P.E. R.A. Address " - i ice No. 1PPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unles structi r� ;n+��,,t @4A9 has been undertaken and is. evocable for cause or may be amended or modified when co ids necessary by the Comm' toner o Health. �a "cfiange or alteration of construction squires a new permit. Approved for disposal of domestic sanit y eewag!,and riv waterG� _ ly oniv, T:}In Aq, _ t .: _ ♦ ^ i'_^ �.0 i �� _• / �j I.i�:�"i %.i^v.4J.• [� ... $-r�r. .- t't... �. 'S�! <yiM YI�...L V. ^� r.. �-+y2_y 0 er or Purc aser o Building M- n cipality Building Constructed by Section fll 'Po .7d �o� �- Location - Street Block ewlf Building Type Lot GUARANTY 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 guaranty to the owner, his succes- sors, 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 de- termination of the Director of the Division of Environmental Health Ser- vices: of.-tne.. patng4 Co :tirrty - Depa-- rtmont. o.f ""Health. -as.':to °.;�rhether -.or ; *_pc t.- 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 .2 z day of /� 19,8-0 Signature Title /t If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION 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 ' PUTNAM CC'•VNTY DI; ART- TMNT or lll'.a All - DateC�� jf Re :. Property of 44c; �i -466 � Located at �o10 /jQ Cr c� Section / Block �. Lot Gentlemen: ff _ This letter is to authorize i"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, ar to sign all necessary papers on my behalf in f connection with this matter and to supervise the construction-of said - system or systems in conformity with the provisions of Article 145 or 147;; Education -'L;avl,: the - Public Health'-Law', an'd the Putnam County ISani- tary . Code.. Very truly yours, Signed r uner of Property Counters' ed; §CiisS °° - Address G o '4 9 P.E., -r ., a Dy`Z` 9�4 9 / ° Telephone Address y e �: �4 °p ° � �g9 0 �• �h 1 , w . aatxasaxeaseu I 3 1980. 2- .- y PUTNAM. COUNTY ' TelePh --'� ' �1EP -L QF li -LT-i ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �! COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 d; S DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM F � Owner Al (.ris�T" r✓ Address Located at (Street /1//,// /, // %4Sec . /9(` Block Lot indicate nearest cross s ree Municipality. �z% Watershedi /�' rL TION TEST DATA.REQUSRED TO D WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth Eo Water Water Level No. Time From Ground..Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches Z 243 / <. 313 *-1,.6/ 4. 3% .4� 24 % 5 1 2 5 ,il II 1 -? Ntni i PUTNAM rOUN 1°Y EP_T 0E HEAD! Notes: 1) Teits 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION - DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES H {� �,,, z . . -, NOz o• -- � . .. 0 DEPTH HOLE „ . HOLE NO--� OLE N G.L. < 1'2 re, l 6" 12" 18" 24" 301 36" 42" 48" 54 if 60" 66" 72" ., .. 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 41 e INDICATE .LEVEL... T,0 fUl WATER rEL RISES AFTEF� BE3NG - ENCOUNTERED - TESTS- t��kDIE —BY=v' _ .. Date C� i DESIGN Soil Rate Used, Min/1 "Drop: S.D. Usable Area Provided j-40'0-0 No. of Bedrooms Septic Tank Capacity f 2;OC� Gals. Type Absorption Area Provided By p L.F.x2�+ _ width.��P ..�_ trench. • ,o OF NFL Address _2-q '7 Z T61- D ,r^. ure THIS SPACE FOR USE BY HEALTH DEPARTP)NT ONLY: "+� °«y�oo 4o, _ �$ g<s��, -` fit, a °• •° ,�,. Soil Rate Approved. Sq. Ft Gal. Checked by_. �� •.•.` ` (4 144,91 p L c" 't4 APPROVED L's OCT 10 19P - ki; i1cl- 2 ol to, :51 �' � -r T" c r - 1 2,50 Ge. -rc. v, 374 . L. F. 0 f 21" -V AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM red - /c- TOWN OF ev 74,A-7 a z7--, -DATE_ COUNT V, NEW YORK SCALE A_$ �Wj. .4,1 JOB NO._ CONSULTING ENGINEERS QmftW4We 4411 r'eer New York Fu a �i S 1: ESTABLISH ELEVATION OF N E 1b P W41DE DRAINAGE OF LOWEST FIXTURE l D' TO SEPTIC TANK AND FIELDS AREA- OR SE%vAGE DISPOSAL O t SYSTEM TO REMAIN UPoDISTURBED.ALL CONSTRUCTCON CONFORM TO STATE �f? i AND LOCAL STANDARDS AND REGULATIONS . . Yee f A. Q °'� �,I4 oti ro j A `a so 5 14m _ S ' , EUYNAM COUNTY �U, 0 ItIbo • O. .� �1�� ` - Y Of HLA _. �.,SEPARATE SEWAGE DISPOSAL SYSTEM T'_ Of NEW C eotiNTY, NEW. YORK _ i u V/ , 40e5 ca~` ULLR/AN JOB NO � SOIL PERCOLATION RATE ....:..:.... MIN�IN1.2 04 GALLON SEPTIC TANK ••%y�ffSS��P CONSULTING ENEERS DEEP ,TEST pp�� / 1-' O Z n 1.. /►O �G�G l/.f� G7 /ELF XABS. TR CH y 0:��OV� C