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Home My WebLink About0070DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -30 BOX 1 00070 f. � T 116* it 00070 t PUTNAM AUNTY IMP AaRTM�NT ;OF HEALTIH Drvrsron of., En'uironmenta/ Heald► Services CarmelN:, Y 10512 �` `' �CERTCFICATE- OF CONSTRUCTION' COMPLIANCE ;F®R SEWAGE ,DI$POSA'L t f. '' = s K Town or Village Mv a {Located' ;at Section `' !Block Owner g Lot -Job e 3 rSeparate Sewerage: System.' built !by _, Addresst �� _: Consisting of'; Gal,: sepLc Tank _;t� _ lineal !Feet X.. - tl(! , w;idth trench, jOther. requirements f -: { Water Supply K7rPubliC S:uPPIy ,From rJ - - t Pnvate- Supply Drilled BY _ ; - -- — - Add r _ sz Building Type..' 3 Goo p ,s- F - ` " ' f ,Bedrooms Date Permits ssueii !� F: y tit -. Has "Ero"sion Control Beerr: Completed _.. _ r. I ,certify that the 'system(s) as, listedserv�ng ;the.above?premses`were constructed' essentially, as shown ori'the� plan "s; of the com -!qt d' work zo yes of which. are to fie - _ , P , (. P ux at_ c d) and ,fin iaccordan- c'ew�th, :the s andards, rules and `regulations, plans f�led;an a perimt !issued Eby }the Pu m County JDepartment�zof xHealth i �� Cer fled by _ R A r - Adtlress icenSe No �' Any person occupying premises served b,y the above fsy_stemps) shalh p_romptlyc6take such act�onyas may be necessary to see a the eorreMion? of any %(UhSan ta'ry: conditions resu'Ifing_ from.)such usage Approval olr the. separa a sewerage system sFiall becoine,nulL: and void as soots as3'a ! u61ic sanifar se iverzbeco'mes available and the approvaL.o`,f Ehe private, watersupply •shall,,become;;null, and .void, •when a 4 public water supply becomes available Such approvals a ?e ' subject, to' modfficat�on or, change .when 'in the judgment bf th mis3ioner of .Health,,; such - cation modrf�cat�on or' change is' n cessary- { B �A— �g- � •�" :�^ Tiitl _ a. � � d:. nc ,►s`i,�c ,,a" :.: !»°� -:e by`s i J 6 '9�4 r`n enq�iiee►".s' ge i�tsjPc�e: WELL COMPLETION,, REPORT P, _JAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report,is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NA ADDRESS e LOCATION OF WELL (No. 6 Street) , ! G /jZ!% `t/ (Town) (LO r) PROPOSED USE OF WELL OMESTIC SUPPLY BUSINESS ESTABLISHMENT INDUSTRIAL ❑ FARM CONDITIONING ZZEST WELL (SPe (Specify) DRILLING EQUIPMENT _ TARP 0 [ IMPRESSED AIR PERCUSSION ❑ CABLE PERCUSSION a OTHER (Specify) CASINO DETAILS LENGTH (loot) Q DIAMETER (inches) g>' l WEIGHT PER FOOT / jj ,�'jj � an'READED El WELDED (DRIIVE SHOE LL1v 0 N CASING �jU ONO YIELD TEST ❑ BAILED �" HOURS CJ PUMPED L.��C_OWRESSED AIR G.P.M. YIELD (G.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specl /y IeetJ DURING YIELD TEST feet) l , �� J Depth of Completed Well in feet below Land surface: SCREEN MAKE r LENGTH OPEN TO AQUIFER (leaf) . DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET Y YC, f If yield w6s tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE_ WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) C Nn Owner or Purc aser o Building Building ConstructE by,,, Municipality Section oc' at - Street Block uding Type Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I an 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 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. 'l Dated this 12/ day of —11W2 19_y Signature 6 Bbd , (/ Title THREE (3) COPIES ARE REQUIRED WITH THREE CERTIFICATE OF COMK ETION WILL BE ISSUED. (If corporation, ive name d -- -- ! - -V'° -- (3) COPIES OF FINAL PLANS BEFORE GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health y V. �- PUTNAM COUNTY DEPARTMENT it HEALTH >. Division of:: Enwro» mental Hea /th Services Carme% 9NSTR'UCTION PERMIT FOR SEWAGE;;DISPO_S4L_SYSTEM. P C Sd - Town ,or Village slag{ �C /D/'� L �S ocated at - Section Block per: w0 a/ t Owner t /.� Adtlress Building' TYPe.�, ` Lot Area Number .of Bedrooms�� 1S� Total' abatable Space- Square Feet!,, gQO Separate Sewerage System t; consist of Gal 'Sepric Tank'. Q lineal feet X 3�d ~ witlth trench. To be constructed; by ' / -� �r�R/t'i /i(%� Address b Water.. Supply; Public Supply ;From G x P,nvate Supply tosbe drilled by ?- , -8� r %�sC%��1�� //�� Address :;Other Requtremehts L:represenf that I'am wholly and completely `responsible for `ilia design'antl location of ,the proposed systems) ` 1) that - the separate sewage disposal_ system above .described will be constructed as shown:on thelapproved amenUment thereto and in accordance wifh the standards `rules an regulations o t e u nam County Department df .Health, and that .on completion thereof a °!Certificate of .GOn'struction Compliance" satisfactory to the "Commissioner of. Hea thwill be submitted to,ahe Department, ::antl a w��tten guarante__*iJ be ,furnished the owner his, successors, heirsor,assigns by the builder „lthat saidpbu�lder; will.; , place in good ,operatm9 "`condrtioR_ any part of _said sewage. disposal system ddring the period of two (2) years immediately #ollow,ing trhedate of the j 4su ance of the approval •of the•Certificate of. Construction •;Compliance of .:the" I system or any repairs thereto 2)'that the drilled•,well described,abdve' will be located as`shown on the approved plan and that said well will 6e'_install aceortlahce _wit the ata aids rule's° and regulatiohs of t ilia Pu4nam 4 County ;Department of Heaoalth °j' Date P'I k - a, 177 Signe P E ppR3 Address i 30�apc fZo�17"Ez Ci9/1/EL.� License s� -- •; _ ran APPROV,ED FOR.CONSTRUCTION, Th�s.approval'expiresone year :from the, date �s'fued unless coris�uction >of the iuild�R9 -has wbeen.underteken and is revocable for cause:or may :be amended or,modiflea,q co_` ed'becesnary by 'the. Commissioner _of Health; Any change ,o alterafion of;construc €ion requires a new permit Approved for disposal of dome Racy sewage n r r water supply only ral }`- Date z �6 - • Title i \� a��. REVIkI� CT�,CK SHII�'' Weets Std. (' ' Remarks 'fie s No L� DOCUMENTS House plans O.K. ✓ y Ivy Design.data sheet. i Peres presoaked? i Min. 30" perc test depth Const . results for 3 runs I I D. Hole log O.K. Corporate Affidavit for other than individual i Authorization for engineer i 1 Letter from Water Supply. if applicable Ad If variance requested -such noted on plans & apps-.; Al 14 I I DETAILS if' change is proposed,) J Existing contours shown show new contours) Slopes for driveway cuts., etc. shown Water service line location N A Footing drain, etc. location I Top slope, bottom slope of fill ALI .Percolation tests and deep test pit location ; — Septic tank size and conformance to std. 3 B.R. house minimum House setback shown ter. 1,11.4i.i•.i I•)ili -1 •._ ll,:r. , ,,; ..�.lc.t 7V� 1.A'V.n7. -..:- 1111_ WcL (,�I• ' 1v1, 4i" 11 :Do 1 .0 U. 'Ul Ili 07' 1i Plan and profile SDS All other wells and SDS closer 200' j shown or reference made I .� Property boundaries (metes and bounds - clearly sho- SEPARATION DISTANCES, SPECIFIED ON PLAN 10' to P. L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. incl 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 & footin .expansion) ®l;�I Qi V k< ® 1%�_ 015. o k Qi V k< ® 1%�_ 015. o k _..b 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 /��2/�4 L /rC1/J�/S/Z /address /1% g ��f� -i 1L Located at ( Street 66,6W RID, See. Block Lot Indicate nearest cross street) Municipality. �jJ77�E/'Sc�it�' Watershed /0�- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches / O lmk tf' 3 4 5 3 Notes: 1) Teets 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. G.L. HOLE NO. 6" 12" 18" !% 2411 3011 3611 4211 48" 54 60" 66" 7211 7"" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED %, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERF TESTS MADE BY b , f Date jl,5 -7.3 DESIGN Soil Rate Usecj/ /S Min/l "Drop: S.D. Usable Area Provided. No. of Bedrooms Septic/ Tank Capacity g6o Gals. Type Absorption Area Provided B��L.F.x2411 width trench -. q fth ,T-- Address THIS SPACE FOR USE BY Soil Rate,-Approved H DEPARTMENT ONLY: Sq. Ft /Cal. SEAL Checked by rn y K 1• !' ^�.n+Y' _ - cK'y,7 -.L '+ik •`'fi's. 7 b, Q' xa °t d L ek Fk EY a o � ►� 4-1 EL s= �n s CL