Loading...
HomeMy WebLinkAbout4623DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -10 BOX 35 04623 1 0 li i r r .. di ■ILI 16 IL 9 , .1 11116 04623 „ f'I DEPARTMENT OF HEALTH Y ` ENGINEER MUST PUTNAM COUNTY DE pROV I DE /� i { ! Division of Environmental Health Services, Carmel, N. Y. 1.0.612 PERMIT # e 0: CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM To_ n or village T. Located gat !-P Block / Owner ` -° Formerly Tax Map Lot # , Subd. Lot N Separate Sewerage System built by i Address ZZ 3 T _A9fJ62 -5� &1 Consisting of J, xJc Gal. Septic Tank and 1Dtz. ' 1 Other requirements 117—FrE4 1rD f4 —t> zA fl Water Supply: Building Type Public Supply From _ Private Supply Drilled By Has Erosion Control Been Completed? of Bedrooms -,*� Date Permit Issued Has garbage grinder been installed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Z) , n (� Date d d Certified by Address b P.E.-�•L R.A. License No.: Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, In the judgment of th Issi ner of Health, such r oca on, modification or than cessary. Date ,T— By Title Rev. 6/85 n PUTNAM COUNTY DEPARTMENT OF HEALTH Permit Division of Environmental Health Services, . Carmel, N. Y. 10512 ONSTFIii ®PI- :?E%t!0i t ' Cri'i'itlAGc'-t7 {z"r�SiaL Sid ^sT� �N .; :: . - Q \j4 iL 0, own iliage ' Located at k W F_ R—TY PLA U_, Tax Map Block Loe L � i Subdivision Subd. Lot # Renewal _❑ Revision' ❑ Owner /Address & AWOV4C4 Date Of Previous Approval Building Type f Number of Bedrooms 8 Design Flow G /P /D 4006 Separate Sewerage System to consist of .�� �t✓ Gal. Septic Tank To be constructed by 49<z � /�{-wL� cz Water Supply: Other Requirements Fill Section Only ❑_ P.C. H. D. Notification S:% and --ft 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 system bove,describeG_will _ be constructed as shown on the approved. amendment there to and. in.accordance with. the. standards, rules an regu a ons 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) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original sys or any repairs thereto; 2) that the,drilled well described above will be located as shown on the approved plan and that said well will be insta in rd c with a standards, rules and regu aeons of the Putnam County Department of Health. , / Date S Signed P.E. v R.A. 1 �O�aS� y Address License No. APPROVED FOR CONSTRUCTION: This appr val expires one year from ine date issued units, construction of the building has been undertaken and Is y revocable for cause or may be amended or modified when considered necessary by the Co ssioner of Health. Any change or alteration of construction requires a new permit. Approved disposal of domesti ni ry sewage, and /or pri to watery supply--only. ` Date /'b e` 1✓(t6a(Ca'� By Title , Rev. 9 -81 .. WELL •COMPLETION"10. EPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/7.11 Division of Environrnetital Health Services COUNTY OFFICE BUILDING - CARMEL. NEW YORK. This report is-to be completed by welfl•;Iler and submitted to County Health Department together with latboristory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. . ,::w���:.., °» .�.x :.••e.. • - -•• -- m�+ F's; 3k�' T= RItIG :�iF' "- �iE'- 'Sllf3lllllyTED° WIYF 'il!`U'�30'iIAYS..OF.:.WE,LL- COMPL�TIUPiI':;:; -•;;�. ..•:..•.•:,..:...,• •;' r.s:..,..• OWNER AM `' ' /l ADDRES _. LOCATION OF WELL fNo. Strad (Town) .fLof-Nanoer) �. PROPOSED USE OF WEII ® DOMESTIC SUPPLY BUSINESS ESTABLISHMENT INDUSTRIAL D FARM ❑TEST WELL Q AIR OTHER CONDITIONING �, (Specify) , DRILLING EQUIPMENT © ROTARY COMPRESSED C� AIR PERCUSSION CABLE � PERCUSSION n OTHER ) CASING DETAILS LENGTH Oast)/ DIAMETE (Inches) WEIGHT f/ PER FOOT ,� THREADED WELDED YES No t:TSTK YES ` ,No YIELD TEST. . C BAILED PUMPED COMPRESSED AIR .HOURS G.P.A. YIELD (G.P.M.) WATER LEVEL MEASURE FROM,LAND SURFACE — STATIC(SpecifrlegfJ DURING YIELD TEST fleet) Depth of Completed Well In feet below Land Surface: SCREEN DETAILS' MAKE LENGTH OPEN TO AQUIFER (left). SLOT SIZE 'DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including , gravel pack (Inches): R VEl SIZE I aJ NN) O (feat) Dt►TH n01A LAND SURFACE FORMATION, DESCRIPTION Sketch exact location of wait with dtafene", to 11 Neat two permanent landmaNta. FEET to FEET • ECE V&D �. 1986 riv 01986 A , ®t�r ®� cou�r� 3J� � - x.00 � - ------ --- If Yield was tetrad at different depth& during drilling, list below FEET GALLONS PER MINUTE DATE MPLET 0 i ELL C / �� OATS OF REPORT WELL DRILLS 'nature) . I Owner�or PI L urchaser of Building -: - i3u.�L�di:r� Conati~u'cteci�%-by Location - St eet f�7= Municipal' y Building' Type 67 Section B1 k; Lot Subdivision Name Subdve 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;.o.f Environmental Health• .Services. _,..,. _. ` ..." ..of' °�'he`�uinam �oiintj��I7�epartme�it .: o.f �He�lth as "'tz5`'�riie°th�r''�Y� ii�'�'�t�7i�� i°�'i�l'- `•�• ,'....,"'. . 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 day of_19` Signature Title���� A 74 ,-fix Corporati Name if corps) Addres THREE ( 3 ) COPIES ARE RA y t,.I�IREE ( 3 ) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETIO�N�W$E @S UED o GUARANTOR IS REQUIRED TO"••fF'-lLZEE SJ, `DICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - -DEPT - - - - - - - - - - - - - - - - - - - Division of Environmental Health 1 rvices, Putnam County Department of Health FIEUID CI11�,r1: i,I ST. cnt:s ,Property lines or corners found . . ... . . . .. Can estimate house location . . . . . . . . : . CR4,ti Date: \\ Y. 2 5 -12 Insp.by: - •.. • _ • _ . . �:!_.1�' _ .•f•- -�;_y. .yy. �'14t•'i.M1i•'+Y. • \../...t♦ iL'4 -- •w��. 1!•YTv. ••.I...•..4�1 .:'W Il`J:f.TTItL S:C`]'r 1 J:T1SI'L'CT7 OT, : Yes No Comm cnt:s ,Property lines or corners found . . ... . . . .. Can estimate house location . . . . . . . . : . -- Jill. drivcway need cut Nrust trees be removed -hote these Is deep ho]e representative of entire SDS Brea Additional deep holes needed. . . . . . . . . . I A677.6- Sufficient SDS area available considering drivcway cut, house location, separation . distances, etc. DEEP HOLE DATA ' rr _ 14ater elevation.: �, Z Rock elevation: Soils description: —7 Date I'Ih' A L STTE TPdSPJEC`!'IO Insp. by: : �V � _ - --- House located v-here 's }got -m on *approved plan SDS located where approved Inns;th of trench moasdred Width of trench ave i a("e S]_ope of the line and trench. acceptable �l Room allowcd for expansion trenches . . . . . Over 50 ft. from swamp, watercourse T�T�- i:ti��1.. �.al� :riot : strPia °�` -erg' -:SDS• ar��,ti: °�_:...� .'-� -. - luuIecFUsarily graded ... .P,:.. ✓ ..� :.�-- - . _< . _ ..o _ .. - _. _ 10 A. maintained from prop.line and 20 ft. from house Separation of trench from house, well ---- etc. - -follows plan h1rdiiber of bedrooms checks . . . .. .-. Stones, brush, , stuinPs, rubble,, etc: greater than 15 ft. from nearest trench . . . . . . " 15 FL . of peripheral soil horizontally from trench . • . .. Junction boxes properly set Could surface run off from dr:imlay, roads, ,.,ground surface, etc. chaimel near SDS . . . Does lot drama ,c anro:ir 0. K. in area of SDS FINAL GP,-ADING OF SITE (ACCEPTABLE ,,x..10 i b" • rl.An ��IITS J 1...i _ p_, :.0 V K Design data sheet Peres presoaked? i�in: 30" pert test depth Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for oth o than Authorization for engineer vid latter from Water Supply if applicaoie If variance requested -such noted on plans o rj 'v V."v Ime'ets Std .1 Roma rks ' es , No ,e- I I . � f apps.= N 1 FIQL(1x� DETAILS if change -is proposed, ) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown T•ater service line location I Footing drain, etc. location ! ✓ i Top slope, bottom slope of fill of •f Percolation . tests and deep test pit location ✓ i s� i NCr✓ - �zc�ItX� o.k Septic tarLk size and conformance to std. I 3 B.R. house minimum House setback shown ✓ f I Distribution box ftg. below frost A),''1' ! ! All water wit hin 50 ft . of. PL shown Plan and profile SDS I j All oth -r wells and SDS closer 200' shown or reference made , .! C PrA.r:tY. b��ri�ar�ies-- �mts-alil boizrids= clearly `s own LECzF}L 5c:$DlU IS lDt�l __f +-� I�i II a k? ecUgL. ' uJ �EALT`{ vv�D1viSICiv `M ,y�� - SErARATION DISTANCES SPECIFIED ON PLkN 10 to P. L. 20 to foundation iaalls T00 to Dearest well ;CU' to stream, march, lake, etc. incl : e 15' to Curtain drain 10' to water line (pits-201) 5' to storm drain �0' ' to lar`,o trees 0' from fot:nd:lt.ion to so, i;ic tank 5' to pi.po from lezldor &- .i'ooLi IC, le 25 To . GiTC 4 @,A $ ttw _ ro lalli on I 1� ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .'q:.. = _+eF'.. .•i.Ci _ .iit •, ., ,,. .. .=e.- r Y3• �. :a i. : . ..7. ",. r ^�• , . c _ ,a . _ , .a,.oa : "1�',i •er•i . a. F• , ,a a, r -K� ,,i. Date J`5 e �cs� Re: Property of Located at (T) Section Block Lot 2— Subdivision of Subdv. Lot # Filed Map # Date IC&V 'VIA Y 2 i985 Gentlemen: - oUTNA M C U OF oNY� This letter is to authorize Off-! t I•/ a duly licensed professional engineer 1./ 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 Isystem- -on systems =..in:: 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very trulv vours. Signed Countersigned: P.E. , R.A. , # VG7 Addres Telephone 6,28 - /8/ 2.. Telephone VL:144T A; Ct 4' Fr 7 C Sr l ID "Si _4 —t—D-JIL �Tr---- A� fttm- County De 71 zelaia 0IT121on 01 m2y,70mmmt13 Health Bervicu� as r ed for coeo-, =c_ T14ch D aril t of law 1• C-Of4P.)2Y'l Tb 'SET P:OzT"i F5" '14F- Z FCLt,F -7 3 1j C> `== tJ 5c r-A '-')v f: D TID 4-�7-EFT Tc AL, Twl� Tt-� 4:, T Arai TIE- RDY Al. q14- M,4312 OF NE IV p� C a3 o° � 0 p L is Z Z A O OK z ip o a C 7 DkO O � fro o� �oo NOW OR FORMERLY Oi MgR,ZO N. O S5 ,301E AREA = /. 020 4Cr4E' � 1 - T .vncr oa. vF� a m - rn t u T T /rLE N° any O� ^K e �.. "MN° _ 2 2 - b R RGELFEENRBE4N00CfE t - D D r b t y c co4luT Y CLEr4/fS OFF /CE O.V /VOI/. 14, /952 AS N° 650. ZMAP N ° y y P PLAYS /CAL L0C4T/01V OF THE PARCEL SHO;f'vN p0 n n H HEREON BASED 0,V DATA 4A/O MOrVL/iL/ENTAT /ON ma m b n r !1 1� L /BER 828, °ASE 7C O,' OeEoS S. O °SS 30 '!I! / 290. 97' -0 kV oR F oRM� 4G Y .9An/TAMO.PEiVA ; O Certified only to DAVID A. SCHM /DT MARGARET M.. HERMAN MARATHON ABSTRACT TICOR TITLE GUARANTEE CO. B.C. PREFERRED BUILDERS Spies from the original of lh/s survey marked with on ar/ginal of /fw urveyor s inked seal or his embossed seo/ shall te considered to be true copies. of NEW yo y�P t E e q� 4T E. BAXTER 8 ASSOC.. Surveyors and Planners )x298 R.O. /,Box 277 -C ,ac, N Y Hopewell ✓el., N. Y '00 221-11.92 yb'Fi�,. 4943 _ to •m SL^ LONGV/E-vv OR/VE �' s °se �Z D Cert/ficalians hereon signify that Ibis survey was prepared /n accordance with the exlsl/ng Code of Pract/ce for Gent Surveys adopted by the 4t;w York Stale Assoc. of Profess/onol Land Surveyors sold cerlifIcalians shall run only /o lheperson for whom the survey Is prepared, and on h/s.behalf to the title company, governmental agency and lending institution fisted hereon, and to the ossignees of the lending tn- stilution. cerlificolions are not transferable to oddifionaf /nslituttons or to sub- sequent owners Onouthor /red alteration or addition to a survey mop bearing o licensed land surveyors _n/ is o Yioldl m of P. of the New Yark .Stafn Fdtu.•olion L ow. 7 SURVEY OF PROPERTY SITUATE IN THE W OF PUTNAM VII L PUTT AM COUNTY NEW YORK SCALE /r =50' DATE: 4PR /L 2G, 1985 /In,, n rc^ . // //(J ­v­ /mac , ■ { ' } | / , 7000' ` � � � � ' | /i ---`---`- | ~ ' ` | / -N /.7-7-7 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES y - COUNTY OFFICE BUILDING dk'M44EL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE•DISPOSAL SYSTEM FILE NO. Owner C�f�d a /es9,y��,,J�.� Address ` Located at (Street ;ier TX cf-Sec. Block _Lot Ica e eaves cross s r e Municipality �!� -�I4 Watershed SOIL PERCOLA ION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Z e h5 � (Wr- , Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to WateF .:Water . ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 ! z Z : 3 30 4 _ _ - AI,- 1.61 Cl, L) er� 5 x in ^�fJ Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each p���'ol�tio�t -:test hole. All data to be submitted for review. " 44ti;:� 2) Depth measuremenE -4-`Mc de from top of hole. A0-,j .2 . 3 4 _ _ - AI,- 1.61 Cl, L) er� 5 x in ^�fJ Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each p���'ol�tio�t -:test hole. All data to be submitted for review. " 44ti;:� 2) Depth measuremenE -4-`Mc de from top of hole. A0-,j DEPTH G. L. 6" 12" 18" 2411 301 3611 4211. 48" 5411 60" 66" 7211 7811 84 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE. NO. INDICATE LEVEL AT =H GROUND WATER IS ENCOUNTERED _ ,INDICATE- LEVEL TO - CH -WATER LEVEL RISES, AFTER. &SING.. ENCOUNTERED TESTS MADE BY r�.. _ . Date DESIGN Soil Rate Used j'--Min/1 "Drop: S.D. Usable Area Provided.5' ��. No. of Bedrooms -"S Tank Capacity 000 Gals.— Type Absorption Area Provided By�L.F.x24" �'- ,..r dtj,- rent .. ivame Address ure SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate A pp roved Sq. Ft /Gal. Checked by a -�ti,-` Da te AGA THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate A pp roved Sq. Ft /Gal. Checked by a -�ti,-` Da te PUTNAM COUNTY DEPARTMENT OF HEALTH DNISION OF ENVIRONMENTAL HEALTH SERVICES 11p ... ..:,.: :; . COUN`�'Y�OEF�ICE "B�TI�,DI1G; C I'' p 5 USN. �. /98 . DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 9 O Owner egA 0 Ovr.> Address (z AwQvac, Air .Located at (Street L01.1G V,gg -be,yo-,Sec.. & Block_TLot indicate nearest cross s re Municipalit 40, y�4�lC Watershed 611wi4 j ya- .. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS •, Role Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water - a er ve No. Time From Ground Surface in Inches Soil Rate;•... Start -Stop Min. Start Stop Drop in _ Min. /in drop Inches Inches Inches it,I 1 .56 / Zo 2 30 1lo Z ic3 /%Z Zc� 3 - - -- - - - - PEOC - kXf, 21- .3 ) 5 -1r, Z. 1 /'7 AS 3d 4 5 2 5 � . Notes: 1) T6#s 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. DEPTH G. L. 6" ` .. TEST.PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE. NO. HOLE NO. HOLE NO. 12" 18" 2411 30" 36.. 42" 48" . 5411 60" 66" 721' lle,K� r�1oJn� 78" 41LI!, c N uj 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED IN??TCATE IE'JEa f[fiCH = WATER I,r ET RISES 'AFTER BEING ENCOUNTER- - • ;.. . TESTS MADE BY o ( s Date DD�lUN Soil Rate Used pMin/l "Drop: S.D. Usable Area Provided -60 �c No. of Bedrooms Septic Tank Capacity % UCH Gals . 5eN " et, d, Absorption Area Provided ByL.F.x2�+" .t Address ure SEAL 'may; ti� S y THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ESSID����C. Soil Rate Approved Sq. Ft /Gal. Checked by Date an