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HomeMy WebLinkAbout4654DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.13 -1 -45 BOX 35 �o .� J T'� r, r- ■ il"T, .r ' -i Rno if �L -r. r 04654 _ � :; PUTNAM COUNTY,? D P r Dvis1on. of Environmental Health Servo CERTIFICATE OF' CONST.RUCT.ION COMPLIANCE F SEIIi�At;E'iy.l, Located at y7`� Ptf �fw ~ '44 ►'�'� 1L/� (i��, ^SeparaterSewerage System built by ©Q l.S�C X11 Address ^ of Gat Septic Tank lines '(° 4j Consisting I Feet" X width tench ea Other requirements Water Suppl y' Pdblic Supply :From' /t _ Private Supply.Drilled' >BY Address . ; LL Building'TypeC� No of Bedrooms Date Permit Issued - Has 'Erosiore' Control :Been Completed' e I certify that-the systems) as Iisted serving the above premise "c u e ri as shown on the .plans of tie completed work (copies' of which are attached),: and in'accortlance•;with the standards,. rules aii plans,: e.permif:'iss by 3 Putnam 'CouWty.. Department of Health:; Date v Cert+ _ F 9 P E R l4, ry Address �` $ :, � ,� !'��' L•,�cense'iVo���,L °{ ,i .! Any person occupying- prerhises served 69: .the above syste s) s ch ion as may be necessary to secure the correction of any unsanitary ' conditions resulting from such "usage : Approval of the'.: Cs� erage she ecome. null and • void -as soon •as a public sanitary sewer becomes available and the approval of the private' water, supply hall• _ s a a'_ public water supply becomes available., ,: Such approvals are ssubject. to modification `or change when; in the, judgma t -9 t;, ,�pn ealtl such revocation modification, or change is necessary r .. u 1 Date �� .; / By i Titie 1 ti } { t G ENT OF `HEALTH ;` 4 ;r s, Carmel; 5 N Y. ,10512 J 09 'jlr' 7'�Cv$` i c7i�t, aSF �''✓v,i7�ry'')" !. t.�l +/ re� Town or.. Village 1 Job { ^SeparaterSewerage System built by ©Q l.S�C X11 Address ^ of Gat Septic Tank lines '(° 4j Consisting I Feet" X width tench ea Other requirements Water Suppl y' Pdblic Supply :From' /t _ Private Supply.Drilled' >BY Address . ; LL Building'TypeC� No of Bedrooms Date Permit Issued - Has 'Erosiore' Control :Been Completed' e I certify that-the systems) as Iisted serving the above premise "c u e ri as shown on the .plans of tie completed work (copies' of which are attached),: and in'accortlance•;with the standards,. rules aii plans,: e.permif:'iss by 3 Putnam 'CouWty.. Department of Health:; Date v Cert+ _ F 9 P E R l4, ry Address �` $ :, � ,� !'��' L•,�cense'iVo���,L °{ ,i .! Any person occupying- prerhises served 69: .the above syste s) s ch ion as may be necessary to secure the correction of any unsanitary ' conditions resulting from such "usage : Approval of the'.: Cs� erage she ecome. null and • void -as soon •as a public sanitary sewer becomes available and the approval of the private' water, supply hall• _ s a a'_ public water supply becomes available., ,: Such approvals are ssubject. to modification `or change when; in the, judgma t -9 t;, ,�pn ealtl such revocation modification, or change is necessary r .. u 1 Date �� .; / By i Titie 1 ti s- - � .. - _ .. .. _. __ _-_+ - ,.�- - e .. ._ __ .. -- _. �_ '..,� ... � .-�,, ,..mow ..:c— ..� ._, w WH.L COVIFUTION'' REPORT FUTNAM COUNTY DEFARTIMAT OF NEAI_T a'3 %71 Division of Environmental livolth Services t COUNTY OFFICE BUILDING - CAr-iNIEL, NEW YORI This report is to be completed by well driller and SUI'Mitted to County Health Department together with laboratory report of analysis of water sample int'icating water is of satisfactory bacterial quality before certificate of construction compliance is issued. ..... ..{ ..., •- SllCtl!�O,iTEL1•�u4'; lit'. l; lt�il���/ �* Y�- ri? �-- V,ft- :LI�;CtI(Vli�iET1hiV'�°T •�- ._a.,�..�:- .,.:�;... = ; =TF'.. gym.:. - .,f:'•`•~�QF3'C..11!;IIST:•BE- .< i...,� OWNER ..a�. ., NA /AE ADDRESS - LOCATION OF WELL (No. & Street)��}}( /�/ , (T'own) (Lot Numb or) f ti AJIi✓T -� V .�' 7 y%,L•' �C 1�7P� _ _ BUSINESS C� CI jrROPOSED L! J DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF ! WELL ❑ PUBLIC r'j AIR OTHER SUPPLY INDUSTRIAL CONDITIONING :_j _j (Specify? t - DRILLING COMPRESSEU CABLE OTHER r EQUIPMENT ROTARY AIR PERCUSSION 0 PERCUSSION t_1 ($Potify) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT jj��{{ DkIVE SHOE ©YES ❑NO WAS CMG ROUI�DP DETAILS ]� f_ G 'r �J� kJ THREADED— LJWELDED L_fYES l._JNO YIELD � ❑BAILED HOURS G.P.M. YIELD (G:PAf.) TEST LJ PUMPED l:Q COMPRESSED AIR 1 " WATER MEASURE FROM LAND SURFACE- STATIC(Specilyloet) DURING YIELD TEST fleet) Depth of Complated Well LEVEL , �r � in feet below Land surface: y`J - MAKE LENGTH OPEN TO AQUIFER (lent) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including _ GRAVEL SIZE (inches) FROM (feet) 70 (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of wall with distances, to,'at least two permanent fandmsrks. - ,FEET to FEET .T . _ If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPL.T.ED 43 ,A*T*E OF'REPORT WELL DRILLER (Sig.natuto) t I --- -- ©�'fi�.'� ��K lsSi�Nl1 1 r� &)iN� Owner or Purchaser of building Municipality - -�— •. -a`� -� n" R. •:i..�dT'��! /SC�� • � �� %A J �L^ /C.J . -. a c�: • . «...o. N:.. „ f rZ {r a i Building Constructed by - eet 4m Location.- Street Building Type V Block 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 `'gstandards, rules and regulations of the Putnam County Department of Health, and hereby` guaranty 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 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 occupant of the building utilizing. the systc.m. 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 :t1-1e buildingg L�;�:il.izing the' system. j.. f _ -- Dated this day of ILA"r- 19_T Signature `title (if corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETIONWILL 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 a fl' t c +. P -y •r .`d" x.T as :.ri ,t a1 -;e � hr..' L+ .. - s S �. •sues' cr :,, •� %'7'r'L.' :. ° O''t . °4, ... ':a.t•; .+ •.. ya, w O a I t • t q. -_ 0. a i xe c � + +.'' j Y .%Doff)' •_,t.��^.:.. ' G•. � ,L� � t.. — ,Of � A C � �t� t i a � • � •1 v t Us i i cirfi1Y that the �e�tafs d system dos coast u*d as hi-- �� f. i aa: t(as far aad.t � syst�ad l f mss : by tE balA tt,was covered The , 6y5E2© pas `cumtrud d W F ='" • - o t %' 1 � y `r .. edttr o8 i�a'.tnlcs aad tee; , , , . , _ ., _ Wit` •e� al - • :. �9 y t � , � � �ESRb. �. } o • !i � a r Fk'� '" a ; � ao a °, bhp %ot - si;'.?.x�T �i err. c+n ..s h�:•;,,.> , .x � :��� •R 95 ,¢,vf,°l3�•• c'�lee� � =ty ,r"'"-+",. ,�;t l:.r ,:�:7.. � �PROV EG OCT 181973 DE OF HEALT4' � 04 �� � r .•. .�p16FGIpg,.DWISIBM'OF i�}�� �t '• t. X � jhMJiDNWNTAL HEALTH SERVICV � : i � - � �' � `= �' �'� 4:o-'' � � � �c: ;• ?;� ,, �> c ' �`'� J s 7 t r ! t C� . � �•, F''� � ;, � �E+'�Y ,�"�✓ V'sXi tC :'�` .M�•`� ! b 1 ..� - - d:.»:t!f3 i f' { rd�, •`- !�?`G.�%!1N ii'C` e.''•rJ` , \�.e'ib+'; .�. � .! , ,•� rs L:E,- � ._...0 a., , yC:.`i«krwe�ir.,(;i +%"Jw��f,R., r". r: e. �" f � 1rT'� ;PUTNA Div /sion of CONSI RUCT,tON PERMIT FOR�SEWAGE 1 k��6 l a2csd v"i --�i- ' m� 15ubdrvision%`�� `' L� L, Y. -' G °e? rte-.; y,^„�,ry yk'+.T'f✓ pia, -" ,�.., TY DEPARTMENT OF HEALTH ' � nia/ Health Services Came/ N. Y,--405' 2 x9 .`,k�r To n or G ,Bock : F { Lot` '�� slob ...� .. rS. 4 t. ` ,;,'.. .,.._,...ty ii;_ /%!l.�'L ...:'�.tJn51>t ".fl' A'1\•'.w /` -/t 9i / 3 Separate- 'Sewerage System• to consist of Gal Septic Tank ° lineal feet X oo W' width trench 1 To be constructed by > �S ctr t ' nt t- Address ®y = y Fu' ,N Y� 1x X p � r „ t a .. t S' 13' S b. k: - 4,t r � ,x f i t 0•:' Y wr C Water Supply t v PUbllc Supply Flom Pnvate Supply to be�tlr,lled by "� i < to F .� r r_ �' - rr « r ,,X e S -�' i r '�, 4 a7 t t r a a � .:Cr tN.r,,; '` f,,, ' +• } n .Addr@55 : c� � .. '` t � � t t. ' 0 3 t ".....� r�•,; ��¢ °�'� �.}+ � s r : x '' x t� s r� ° :� �7 � w Other Requirements r a _ c car a v1 r t t �..��? � ��rw- trlb`al^<rk '1,1p c 7'� 1u Y..; }E�,.? =: "' ,. "n• £'s'''�' ,.,; 4z� F represerit that I ;am wholly and comple T �gn`and location of the proposed '`syiterrj(s).;,1) that %the separate sewage disposal system above described will be constructed ast �` p a ment there to and inraccocdance with the stanpards;riules•an ; regu a,.lons,o e' , u nam 'County Department of Health, an m let ioq; Cbetrficate,Iof Construction Compliance s8tisfacEOry to tfie Commissioner oi Healthwtlf t ,, be submitted to' he Department; ' s " > the:blde;that said,bUilder. will to ear 3uccessors heirs'or assigins'by w ,,, place' in good :`operating: condition e I system durmg'=th rioof two (2.ars m_ tel followig; he data' of the issu- tx fence of the approval of, ;the Cert c of: D of, ti'e Qriginat system or any repairs thereto 2)`that :thwdrllled well described„ above will be. located as shown ori,the a v d plan Wit" i} III II b' install ` ��n accordance with`:.try Istan'dards rules and ,regula— o of''ahe' `Puttnam 1County Department of Health PP t K Date l� �9 (r' w�fO � • p'E =:,,RfA �7 !% �� License No:,-3 z% APPRO.V.ED FOR CONSTRUCTION This. a a year, from the �ite° issued unless con'structwn of the building'has been undertaken >and °is (� revocable�foi cause or may be amended or riiodi ,y „considered necess ry by+ the CommissionerYof Health f1ny; =change'or alteret on,of construction 'requires ar new permit Approved for disposal of.;domestic n�tery sew and/ r, rry to water supply �� ' t a, `Tale � 'dJ���.:��casaA i Y'n.Nr F 1 n ; 1, ..x �.. �„ t_ �.. 1.._._ :.�..._.._.,.'Y:...,�_..�.�.< �' - _�_..�._ j��_.;.:_r?<..rL•,sc � .!�.�,- !`�.�.- �_''...�` °'��a �� __._�.�'� �. 4 ,+V�.t� � ...� r,. � _..�. w�4•_�..� �.Y..,_. -..�. -- ( • V �C0JUT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date— Re: Property of 9c>& xna. I R, 1.Sa L -- Located at :S;-1LP +tt ! oJM ( yN 10" i V'IE' 1 ���..� !'"4,�u+ -�� t«2� • � i � Block 0 Lot .1 P1, Gentlemen.: This letter is to authorize ` STANLEY I LANDER a duly licensed professional engineer or registered architect (Indical-el— to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Lepai tiicnt Of Heditil, cLild to sigh 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 :Education--,Law, , the,`�Publ-i.c Heal h_.I,aw_ o aria- ihe. Putnam Cc�urity Sarii- tary Code. ountersi. RTANLEY J. LANDER (Seal) Very truly our - Signed l " 7 `/ 4� Owners Property PO4 IL 6 S�uQ 04Z Address 2 �.. /-7j Telephone Vale,' 5�B R. FIELD CHECK LIST STEP/ /¢"hi, �M /TN 'DX 1 � Date: -Z7 -73 r' Insp . by : i >, INITIAL SITE INSPECTION IYesI No I Comments ...Property lines or corners found '. Can estimate house location . . . . . Will driveway need cut : Mist trees be removed --note these Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . . . Sufficient SDS area available considering driveway cut,house location, separation . distances, etc. . . . . . . . . . . : DEEP HOLE DATA Depth: Dilater elevation: Rock elevation: Soils descri -otion: Date: FINAL SITE INSPECTION Insp. by: House located where shown on approved plan. SDS 1no?.1e where ..ar.)rrover.. L___4 t-71 _._� _ _....:..... Width of trench average' Slope of ti le line and trench acceptable.. Room all.owed for expansion trenches Over 50 ft . from swamp, vatercovrse 0 Natural soil not stripped or SDS area . - . -aa. ecessa; °il 10 Ft. maintained fro--m prop . l n° and : 20 ft . from house . . . . . ..: Separation of trench from house, well etc. follows plan . . . . . . Number of .bedrooms checks.' . Stones, brush, stumps, rubble, etc. greater -- than 15 ft. from nearest trench 15 Ft. of peripheral soil horizontally from. V trench - Junction boxes prop--.' ��1y .set V/ — Could surface run off from driveway, roads, ground surface, etc. channel near SDS,. area. . . . . . . . . . . . . . . . . . Does lot drainage appear O.K. in area of SDS ✓` FINAL GRADING OF SITE ACCEPTABLE 4. . 1. 1 . i 7`iG V4Ie SfP��EJ� .Sm /f/f ,7]r REVIEW CHECK: SHEET IMeets Std.( Remarks es f No DOCIR ENTS. =E t..r.osv .. it =..'!t QS..�..� ;.c.. ,p �.. t..4,r -. .{rr -q.; - ws' :'y is .l :ei•r -F�Y.n :a:t �w.eea .KC_. <:.. _. :p: :'».- .•+bY:: m.. ......4., —:T House plans O.K. Design data sheet Peres presoaked? Min. 30" perc test depth Const. results for 3 runs D. Hole log 0. K. Corporate Affidavit for other than individual A(A Authorization for'erigineer Letter.from Water Supply if applicable. i A If variance requested -such noted on plans & apps DETAILS �f change is proposed,) Existing contours. shown show new contours) ✓ Slopes for driveway cuts, etc. shown Water service line location ..% Footing drain, etc. location Top slope, bottom slope.of fill i o,A Percolation tests and deep test pit location / Septic tank size and conformance to std. _ 3 B.R. house minimum House setback shown L1stl'1bUU-LUJ,1 I�Cl1i 1 L,g, IJG_L frost) All- 'water within 50 ft.-.,-of PL 'shown Plan and profile SDS .... " .... i... �................� . All other wells and SDS closer 200' shown or. reference_ made . . ...... ..... ,Property ouridaries (metes and bounds- clearly shown 1 SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. incl.exT 15' to Curtain drain 10' to water line (pits -20 15' to storm drain 10' to large trees 0' from foundation to septic tank 5' to pipe from leader drain & footing U1 on I/ :ptgAM- CO'ONTY:DE9PARTi+IN4 ='0F IIvAI;I'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y.' 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner t 5i_f_ /c'.. Address Z'l-4p0 A �J Located at (Street 1pp4 �y A 22. Block 01, Lot % $i n .icat e nearest cross s ree Muni cipalityy ! jW a � u, Watershed y jCS1�ILL. VC.�� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse p o Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop In Min. /in drop Inches Inches Inches �e 1 � =�% Z�f�' S / fig' /2� � �•7 3 -2iZ^ G 17 `7-0 7 -0 e....... ... �'fi. 5s• -.r 'f. .rev ..�._5. ... .a.,,, ".�. .`„y.: ay. �f... .. ... .ya ._�.�... _.... ..:,y.,. .�... 3 `3 -� 3 3 J 7 c ,3 lei ij2- 3 Z %% 4 5 1 2 3 Notes: 1) Te':�ts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G. L. 6" 12" 18" 2411 30" 36" `t2" 4$n 54" 60" 66" 72" 78" �_,i .-TEST.. PIT DATA REQUIRED TO. BE . SUMITTF .:APPL_ICAT.ION.._:..,.: DESCRIPTION OF SOILS iintoN VTERED 1N -TEST HOLES HOLE NO.- HOLE NO . ,V, HOLE -t—T 14 Z y 8411 --- ­,- ;INDICAT.E; LEVEL -AT •W'H ICH GROUl'iD 'WATER -I" ENCOLiNTE'�ED,- INDICATE LEVEL TO WHICH TER LEVEL RISES AFTER BEING ENCOUNTERED '.TESTS MADE BY Dates DESIGN a/ Soil Rate Used_ % Min/1 "Drop: S.D. Usable Area Provided`''°' No. of Bedrooms 4_ Septic Tank Capacity IZo Gals. TypAlec.: -1a f 6„t, Absorption Area Provided By '� 3v, L.F. x24" '—•l width trenc �— Other Address ft 1. .r 4-M THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq6 l.,j., eke Date N cT' w. a 8411 --- ­,- ;INDICAT.E; LEVEL -AT •W'H ICH GROUl'iD 'WATER -I" ENCOLiNTE'�ED,- INDICATE LEVEL TO WHICH TER LEVEL RISES AFTER BEING ENCOUNTERED '.TESTS MADE BY Dates DESIGN a/ Soil Rate Used_ % Min/1 "Drop: S.D. Usable Area Provided`''°' No. of Bedrooms 4_ Septic Tank Capacity IZo Gals. TypAlec.: -1a f 6„t, Absorption Area Provided By '� 3v, L.F. x24" '—•l width trenc �— Other Address ft 1. .r 4-M THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq6 l.,j., eke Date