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Home My WebLink About0060DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -13 BOX 1 I W. ills NN 1 L NN 1. ■, ti - K :� i T k r .1 111.1 -Ad 8ss °�/ .. f/ V . .. Ally. :� j Building Type o. of Bedrooms Date Permit .Issued f Has Erosion Control .Been Completed. I certify that the system(s), as fisted serving the above premises were constructed essentia as. shown on'the; plans of the completed work (copies of which are attached), and iinn accordance with the:standards, -rules antl regulatior�s; plans filed, the pe it '_ ued y 'the ' Putnam County 'bepartment.of Health. Date '<J ' - Certified by Address License No Any person occupying premises served by'the above systems) .shall promptly take such action as may'b'e neces to secure the correction of any unsanitary conditions resulting from such. usage. .Approval. of the separate sewerageaystem shall become null and void as soon as a public sanitary sewer .becomes available and the approval of the,.priv'ate' water .supply shall become rull and void when a public water supply .becomes available, Such approvals. are ,subject to modification or change :when,. in the:' judgment of the, commissioner. of Healtfi,:_such on,',modification or change 'is necessary. Date -16,7 l� BY ®r ' J �aG Tit le Owner or Purchaser of Building Building Constructed by Lo/caati n - reet t 11-� Building Type m. d s_. -'t�Vron - (�, Mu icipality Section 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 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 systerl, 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 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 the building utilizing the system. r Dated this % day of it �� 19� Signature /�./J6� G��rrr Title 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. } a jt- r. v� a K { l s�. +e E» 3 { ' �i 4 w a � t y Y } i { _ i -,r i R T .tea "tss OFN- r 4 x. a x.90 y s -C: Ess' fill /ll_(F111��_� X tr l s�. +e �i � f ' ,f""Mtl+OM14�', t y Y } i { _ i -,r i R T .tea "tss OFN- r 4 x. a x.90 y s -C: Ess' fill /ll_(F111��_� 7 777T7 . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of:,Environment-^I ,Health Services Carmel N Y 10512 f CONSTRUCTION PERMIT. FOR SEWAGE DISPOSAL SYSTEM` V - - l .., Town' ors Vil e t located at Section Block Subdivision, Lot ry LYU� Address Owner J Building Type -,/�� Lot Area Number of ,Bedrooms - %�`��J Total Habitable Space Square Feet lineal feet X e� Separate Sewerage System to sist of., GA. Sep' Tank o width trench To be constructed by [.^1i Address i water Supply: Public Supply From .private Supply ;to be drilled -by is Address, > - Other .Requirements I represent that I am wholly and completely -responsible for the design and location of the proposed systems) :1) that. the, separate 'sewage Iisposal _system r r .. .above described will be. constructed as shown -on -the approved amendment there to and in 'accordance.with the standards, rules and regulations of,-. :'t the u _nam- • "County Department of Health, and that on completion thereof a ".Certificate of Construction Compliance'.'. satisfactory to ihe,Commissjoner ; of Health will be, submitted to the Department, and a •written guarantee will -be •furnished the owner his successors, heirs or assigns by -the builder, "that slid' builder will.: i 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 on 1'system or any repairs thereto; 2) that the drilledrwell.descr\ibed above will be located as shown on the approved plan and that -said well will be install, ccordanci with- -the. st rds- •rules and regulations of the Putnam ' County De artment of Health. I P: ER A i Date / Signed Address l/1 6/.I // /� �- License No `�T APPROVED FOR CONSTRUCTION: This approval expires one -year from-the :date- issued unless-, constru on of 'the building has been undertaken ' and'is -. revocable for cause or may be amended ormodif eii whenconsi necessary by the, Commissioner of :Health kny.,change or alteration of construction ,. - requires a new .p rmit. Approved for disposal of domesti sa ary sewage, a r at pply.,only I Date J� -/� ( By _ Title f'r` Ic PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Addressi�� Located at (Street Sec. Block Lot rydica B—a;egr cross street) Municipality, /iOh Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITT WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to 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 1 1 2 3 4 5 1 2 3 5 Notes: 1) Tests to be repeated at same depth until aroximately equal soil rates are,obtained at each percolation test hole. A11 pp 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 DEPTH HOLE NO. / HOLE NO. HOLE N0. G.L. 6" 12". 18" 2411 3011 36" 4211 48" 54 6o" 66" 72" 78'1 8411 INDICATE LEVEL AT WBTCH GROUND WATER IS ENCOUNTERED No,fAE INDICATE LEVEL TO RICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS'MADE BY *� Date DESIGN Soil Rate Used ,/-/S Min/1 "Drop: S.D. Usable Area Provided 5-a-OV No. of Bedrooms Septic Tank Capacity '2)&0 Gals. Type Absorption Area Provided ByL. F. x24" Tc� wti�� trench. Address 7,�'pO TF- yy J2 SEAL= z',; K THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: �FFSSI�NPti Soil Rate Approved Sq. Ft /Gal. Checked by Date +J J) C1;ECK LT_"')P . • Date.: �•; Insp. by: t INITTEAI. SITE -INSPECTION Yes No Comments Property lines or corners found , Can estimate house location Will driveway need cut . . . . . . . . . . Must 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 H012 DATA Depth: 'dater elevation: � r Rock elevation: / Soils description: ��d --'^- X70 Date: -:- FINAL SITE INSPECTION Ins p. by: House located where shown on approved plan. .., STS ��a.tPri ZTh�rP anr_.rnp ?� _ _ ^� Width of trench average Slope of the line and trench acceptable , Room allowed for expansion trenches Over 50 ft. from swamp,watercourse -- Natural soil not stripped or SDS area '- unnecessarily graded , 10 Ft. maintained from prop.line and 20 ft. from house , Separation of trench from house, 0 well etc. follows plan . . . . . & , Number of bedrooas checks . . Stones, brush, stumps, rubble, etc. greater ' than 15 ft. from nearest trench . . . , .15 Ft. of peripheral soil horizontally from trench . . . . . . Junction boxes proper -1y set Cov1d 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 iLCI V -L.L WIL' UA Of]j_'.L J a Meets: Std. ' es No DOCUIVIE NTS House plans O.K. Design data sheet Peres presoaked? Min. 30 pert test depth Const. results for 3 runs D. Hole log 0. K. Corporate Affidavit for other than indivi Authorization for erigineer letter from Water Supply if applicable If variance requested -such noted on plans • Remarks ,f DETAILS if change is proposed,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown Water service line location Footing.. drain, etc. location i Top slope.. bottom slope of fill ! Percolation tests and deep test pit location + —T– Septic tank size.and conformance to std. - i I 3 B.R. house minimum i i House setback shown %t7w t>.j.l WQ•UC'.!• Nf J. VLJ111 JV 1 V e V1 i.� uiiv it is Plan and profile SpS _ . .... - - -• All other wells and SDS closer 200' shown or reference made' Property boundaries (metes and bounds- clearly shown)IL., i SEPARATION DISTANCES SPECIFIED ON PLAN' 10' to P.Z. 20' to Foundation galls 00' to Nearest well 6 50' to stream, march, lake, etc. incl.expansion 15' to Curtain drain i 10' to water line (pits -20' 15' to storm drain 10' to large trees i N' from foundation to septic tank I i 5' to pipe from leader drain & footing drain 100 'a n •, E� �' �"� '" ! aw r � � "� � a -. � � r� ,� � va- rr n � ,+��` r r � `T � o x '� �.��; it ��'S a J�' §t� � ' qua "7' ``' ! ��`t' j - �