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Home My WebLink About4501DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -35 BOX 34 04501 a elm � , �+. ., r , 04501 R, PUTNAM COUNTY DEPARTMENT OF HEALTH .-g Division of Environmental Haa/df Servioea, Carmel, N. Y. 10312 Permit # CERTII iCATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM T - Located at Tax Map Owner 2C / Formerly Tax Map Lot # 2 Separate Sewerage System built by �w�r7er- L Addsryess� - - = %�Y Consisting of /&%& Gal. Septic Tank and Other requirements Water Supply: _ Public Supply From Private Supply Drilled BY Building Type n //� Town -or Village_ . �... 'Block S.W. Lot # No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the'Abbve premises were constructed ess of which are attached).,. and in accordance with the standards, rules and regulations, .1 Putnam County Department Of.Health': Date ertified by Address '� Any person occupying,promises served by t above systems) shall.promptly take, such p�ct� conditions resulting jirom 'such usage, proval of the separate sewerage system 0.1 14 available and the aDprayalvof the _private water supply shall become null and void when subject to modification or change when, in the judgment of the Co er of Meal1 .. I Date By I Aikk Rev. 9 -81 YCTIO.N .P&MITs46 Located at —17V /V;O Subdivision °,.° a e the plans of the completed work ( copies ,filed plan, and the permit issued by the P.E. R.A. a n !✓ 7 �7 License No. cessary to "'secure the correction of any unsanitary void as soon as a public sanitary sewer becomes wupply becomes avallabhL Such approvals are loin, modification or change Is necessary. Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. y 10512, Permit # SEWAGE DISPOSAL SYSTEM r s e ) Town or V / Ilage / .off Tax Map _ 2't% Block J� Lot Subd, Lot # / 2— Renewal Revision 0 Building Type `� Lot Area Number of Bedrooms , Design Flow G /p /D c� Separate Sewerage System to consist of fa �tl Gal. Septic Tank To be constructed by Water Supply: _Public Supply From 15e8 Private Supply to be drilled by Address Other Requirements Date Of Previous Approval Fill Section only ❑- P.C. H. D. Notification Required and S 7j 4 c37 Address I represent that 1 am wholly and completely responsible for the design and location of the above describer! will be constructed as shown on the approved amendment there to and in accordance with the sstandards. rules and 07 a ons 07 disposal u system County Department of Heath, and that on completion thereof a 'Certificate of be submitted to the Department, and a written guarantee will be furnished the own,p��,60 Hance" satisfactory to the Commissioner of Health will Place in good operating condition an +wbri C��o ante of the a Y Part of said sewage disposal system ri I a kd errs or assigns by the builder, that said builder will approval of the Certificate of Construction Compliance of the origi I $ e Will be located as shown on the a � �q�a�� g�.. ears immediately following the date of the isw- County Department of !Health, approved plan antl that said well will be installed in ereto; 2) that the drilled well described above Date /.ate / co ►�cr! wit`th(gta ds, rules and regu a ons of the Putnam V, r a .° , APPRO\ revocabl requires Date Rev. 9 -81 P.E. Y R.A. License No. �_ 3` . the building has been undertaken and is Any change ofieftVVNQ,n of construction Q' �-7 permit oPUTNAM_CQWTY DEPARTMENT OF HEALTH % d �sion iv' o f Environmental Health' Services; 'CaMiet-N. 'Y. -40512 � O CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Al LG � y� /yJ Jr Town i lage Located at ro�W .10- ri Tax Map "�' Block Lot Subdivision s 4 ,� � Subs. Lot N a Renewal _Ij Revision _� 8th &W Building Type ►�-� Lot Area Number of Bedrooms 3 Design Flow G /P /D Separate Sewerage System to consist of / Gal. Septic Tank To be constructed by Water Supply: Public Supply From B� ► �' �� `� Private Supply to be drilled by Address Other Requirements Date of Previous Approval Fill Section Only ❑ P.C. H. D. Notification Required and 2— 4- Address 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 stem above described will be constructed as shown on the approved amendment there to and in accorda,ncsltsesbyfandartls, rules an regu a, ons o e Putnam County Department of Health, and that on completion thereof a "Certificate of Constructio ' rrQliar�t�Dtactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, h rpso"rs di'�p°, ns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the r� �%$ °y�ael�fnf)jediately following the data of the isw- ance of the approval of the Certificate of Construction Compliance of the original sy ems at repairs rjto; h that the drilled well desuibed above will be located as shown on the approved plan and that said well will be installed in actor it t anda,° rulel and regu a ons of the Putnam County Oepar men of Health, o *S a ° re Date �- igned P.E. ° R.A. I �/ °� Address �' sX L''?rV ° G ° License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issue �p� • c$nst�icye °aE� [ building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Co 3 14010161 h.�L'adi'ny change or alteration of construction requires a new permi Approved for disposal of domestic sewage, a d /or pr e Fyn? % A$g4a Date �TTI By C9 Title IF Rev. 9 -81 O r or Purchaser of Building Section Building Constructed by Block Location - St feet Lot Ile, tl '0�j �41 4b Municipality / '� Subdivision Name As/ Building Type Subdv. Lot # R f 5 GUARANTEE OF SEPARATE SEWAGE SYSTEM I reesent that I am wholly and completely responsible for the location, okmanship, material, construction and drainage of the sewage disposal srystem serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and rfL.aceordance with the standards, rules and regulations of the Putnam CouritjryDep. ent of Health, and hereby guarantee to the owner, his success- ors, heir8�:oiA assigns, to place in good operating condition any part of said system constructed by me which fails to A,perate 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 aceept_Aq._conclusive the determin- - - at�on- cif the �Di� c -t ar of---the Division 'of�-Environnient l' H-eal'th-Servi'ce's of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this J� day of 19 dW Signature I�Lr, Title 3 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES //Date Re: Property of Located at (T) Section Block Lot Subdivision of Subdv. Lot # 2, Filed Map 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 system or systems in conformity with the provisions of Article 145, or 147, Education Law, the Public Health Law, and the Putnam County.Sani- tary Code. t Countersigned: R�ti OF P . E . , -R--A —, # ess % Tel — ham^ -.-- Very truly yours, 2 �� 'r e. Signed caner of Property Address Town Telephone RECEIVED MAR 11 1983 i)UV- ,,,W -A COWNTY t b PUTNAM COUNTY'DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL-HEALTH SERVICES COUNTY OFFICE , FiJ11BING ...CARMEL; N . 'Y': ` -105I = DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ,,�,, ,o 41Address Located at ( Street "* ? Ate, <4 e'" sec. A� Block�Lot � inmicate nea esU-cross street) Municipality f'"�J)► // /'e V Watershed TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 2 3 5 Notes: 1) TE'�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. Hole Number CLOCK TIME PERCOLATION PERCOLATION apse . No. Time Start -Stop Min. Depth to Water From Ground Start Inches Surface Stop Inches Water ve in Inches Drop in Inches Soil Rate Min. /in drop 621 31 _ 7% 43 2-,Y .3 _2 6' C'/' ?i% � 2 3 5 Notes: 1) TE'�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. 1 TEST PIT DATA REQUIRED'TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DyPTH -'IiOL NO d �' • IOL� N0. / _: HOLE 1V0 . - G.L. 6" 12" 24" 30" 36" 42" 48" 541' 60" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED�� INDICATE LEVEL TO YMCA WATER LEVEL RISES AFTER BEING ENCOUNTERED DESIGN Soil Rate Used& Mir/1 "Drop: S.D. Usable Area Provided 4�;° d eJ " No. of Bedrooms -3 Septic ' Tank Capacity J &9c- � Gals. Type Absorption Area Prided By, _3ejLL.F.x24" width trench. OF Ufa er Address THIS SPACE FOR USE BY Soil Rate Approved ure DEPARTME-NT ONLY: Sq. Ft /Gal. Checked by ° Qt�0. 248SO 5 �; ° /JC�PS•eo °a° 809 o-s;Pg��E$SiL��a ae� Qbs.40b9bb °e Date �- V 'MAR 1119V, DEPT. OF HEAD i L—Z �:7 j V,, 7e J `' Putnam County Department of Health Division of Enviro antal Health A-- RECEIVED lVgrcv23 ^.-r cc--rormanoe with EZT "tions of tae -Y-- Ith Dz3artment. MAR 111983 -OF-HEALTH--.-..--'e PUMAM COUNTY Z DEPT. I-D 0 ti� . Roos ......... IS 248910 .-' .... SSI .... IA1- ',I, f7 - � •j- J L-.L 6� w e3- 2-3 NI V<�A 4 �1 i' f t; r 4 c,0` :fj1/ c?�,`• "'^-� .. ?l;A,,a6' 11, f ' I r • h:$ E 'A f ,