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Home My WebLink About0303DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -1 -50 BOX 4 1 rs 14111, a 1 1, Lima IN @6 all Y i 00112 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Date A40A&O 0% Located at U'!�Wdfd (T) 2AEZE52� Section Block Lot Subdivision of A Subdv. Lot # -43 Filed Map # 1045 Date 3--U-6of 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. Very truly yours, &L-. L_ igned Countersigne wner of ProjTerty ., R.A., # Address ("'box Addr g s�s VV 0 Telephone Town Telephone 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. Ownerr�d 14 MiU ?0o e.1 Address Located at (Street } Lnu.:VW,4�/ . D Sec. Block Lot Indicate neares cross street) Muni ci pal itySt7it( Watershed V ,/ . C SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION., Run Elapse Depth to VaUer Water ve No. Time From Ground Surface in Inches Soil Rate . Start -Stop Min. Start Stop Drop -in Min. /in drop Inches Inches Inches 2 31Z 2 10:ol - iZ', 5 Notes: 1) T&'ts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 6" 12 "� 1811. - 24" 301 361' t CL 42" 48" 5411 6o" 66" 72" 78 84" J INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. �1 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used-;11:5 Min/1 "Drop: S.D. Usable Area No. of Bedrooms Septic Tank Ca pac— ity –Gal Absorption Area Provided By L.F.x24 "� o � n.. ead Name ig Ta ure ''l L Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date N 4W Ce 67 0,-4 0,0- t�07_ /X0. 41 1 TITLE NO. SURVEY OF PROPERTY -PREPARED FOR ,0" Z01 1X9 43 4tSr .0rh0e407 217 47 CZ-474-7 Z-1 11ml -/x/,W,,0 017a - "Vmv - 710AWY 4.2,4' Said map filed in the Painarn. County Clerk's Office, Division of-. Land- Records as Map No. 900 Scale: I"=50' Possession only where indicated Surveyed.- 11ine 4, 19 ®3 and map prepared, -Tune 28, 1983 New York State Licensed Surveyor-No.38504 Guaranteed to: In accordance with the existing Code of Practice for Land Surveys as adopted by The New York State Association of Professional Land Sur- veyors, Inc. Alteration of this document, except by a licensed Land Surveyor, is illegal. Ail certifications are valid for this map and copies thereof only if said map or copies bear the impressed seal of the surveyor whose signature appears hereon. H. STANLEY JOHNSON I LAND SURVEYOR - 173 LAAinq+on avenue MT. KISCO, N Y. PO. BOX 93 formerly, Fowler Associates JOB NO. b83 -01113 COUNTY" DEPARTMENT OF HEALTH A z Perm =t a `�_ �- Ti of�Enwronmenta/ Health` Services Camel N �Y 10512 CONST,RU TION PERMIT FOR SEWAGE DISPOSAL SYSTEM r K 1Town or Ilage s y yy w Subdivision � Subd �I,ot # Renewal' �.: ` s 'Revision � 1� `.} < � Owner/ Address \N :ay 'Go �'� Date of Previous Approval - , (Building TypeiT�T ��`7�— Lot Area ► �7 F� Fill section onlyn(] x �Y` 7Number'of Bedrooms Design Flow G /P /D' P C H D Noti "fication Requared - 5eparate..5eweiage SYsteri; to consis t of Gal Septic Tank k and 7 oe�� -li�i' ti P 5 PTO be constructed by ' �3+ s Address J diWater SuPPIy PubUc Supply From iA ' ., . }E Frwate S'uPply t0 be dr�lled'FbY " # Other Requ�remantsI_l �(�+� J represent that I am wholly antl coinpletelyiresponsible for.the tlesign and locati on of 'they proposed systems) 1) that the separate sewage disposal •system: E, above'despribe will be constructed as shown.on the:approved amendment thereto and in accordance with,the standards rules an .regu a �onro o : u nam County;}Department of Health, and that °o Construction'Comp0ance saUstaetory to the Commissioner of 'Health will` Elbe submitted to ;tha Department ��and a written ,guarantee will be <,furnished the owner his successors `heirs ors assigns by the builder that said builder "will �� j,place in "good operating •condition; any part of said sewage: disposal system during the period of two'(2) Years im diately tollowug ttietlate Oic'the issu= :f ;ante of '_the approval of 'the Certrf�wte of; Construction Compliance of the-.ongmal, system or any,repa�rs the►ato that` d'Gilled; well described above 5 wilt tie'.Ipcated as shown omthe approved plan and that'said wall w�li be; installed* in accordant with t stand ds ul s; an e9u_a ions ,OT the ti Putnam _ �; County Departm nt of ealth x Date C] t Address L�Cense =NO a ., APPROVED FORCONSTRUCTION This approval expires one year ,from the date issue un ss construct n ;of the uildmg has been undertaken and revocab "le:for cause or maybe amandetlFor mod�f,ed when Eder 'necessary` by the 'C minis onerAof^H Ith . Any ehange'or teration of construction" iequves 5 new permit approved; for disposalof dome e; nit ry sewa 'and /or p ivat ater ppolr_oMy s h f Date �% By Title .' j p'Rev 9 sl r� a T I PUTNAM COUNTY DEPARTNENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER S jt PLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT (Name of Owner) (Stz INITIAL SITE INSPECTION Wetlands on /or proximate to property .............. Property lines or corners found .............. ... Can estimate house location....... ... Will driveway need cut....... .............. ... Must trees be removed —note these........... .. Deep holes representative of entire SDS area.. ... Additional deep holes needed ........ .. ...... • .. Sufficient SDS area available considering driv % cut, house location, separation distances,et",. . Adjacent wells/ septics ........................;.. D. H. 1 Lot Depth to G.W.. Depth to rock Soil Descri tion 0 ft. 3 f t. 6 ft. 9 ft. 12 ft. DATE: d1 zro INSP. BY: D. H. 2 Lot Depth to G. W. Depth to rock Soil De cri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft.' 9 ft. 12 ft. Soli uescri DATE: 5 Z FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan.. .......... Length of trench measured 9 06�1 Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... .... ......... 10 .ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Starves, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench....... ........ 15 ft. of peripheral soil horizontally from trench......... ............. ...... ... ... Boxes properly set .. . ........ ................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... EINAL GRADNG OF SITE ACCEPTABLE.. L �►-d to �-�o', s e71 ��' R' 41 }�a e a .1 .Q Lit LL HA ko j \ r