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PUTNAM COUNTY
�--G -a tA. A^ A -..•. +�•..t mot'.
y
=15 -1900 1923
FROM, 'TO ,;.. :.
22257557E ._ 02'' -::w
FUT'NAM COtJWY DEPP.RL OF IirALTB .
DMSION , OF EIQtTIRMX NTAL Hk ALM Sr'MCr'rS
Owner. or Purchaser of Building.
Building Constructed by
Location - Street "-
���'� -ems -- -
Municipality ..
Buildi Type
Section, Block . Lot
Subdivision Name
'Jr
S vision Lot
GUAM= OF St;i3SUM M SZWE DIS OSe L S1'SM
I represent that i am wholly and completely responsible for the location,
worknmanship, material ' . const_ru. ction and drainage of the sewage disposal system
serving the above described property, and t it has been cxnst=cted 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 Smith, and
,hereby guzxantee to the c&mer, his• successors,. heirs or assigns, to place in good
operating conditivii any part of . said system constructed by me which fails to
operate for a pexaod of two years intnediate7.y following the date of approval of the
"Certificate of Construction; .Compliance" for 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 _.tire occLVant of the building Utilizing
the systeri. '
The undersigned further agrees to.accept as conclusive the dete=Lnation of
the Diiector o£ the Division of Envi.ronftental Health Sewices of the Putnam County
Department of Health as to whether or. not the failure of the system to operate was
caused by the wi11 fia1 or negligent act of the occupant of the building utilizing
the system.
Dated this day. of 19Q9 Signature.
Title • / `t. ,�6LS) _
General Cortractor (owner) Signature �lViCCx X-,)
Corporation Name (if Corp.)
Corporation Name (if Corp.) Cc i(, Q� �� u Li Ll,
Address
Address
rev. 9/85
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DIVISION OF ENVIRCNMENM HEA,LTH
SERVICES
Y FILE NO.
Owner. . , .ld� o c
Z ,� —41vdv-.. Address
Located at (Street) �A�g•%� Lev. Sec. /$ Block 3 Lot �--
(indicate nearest cross street) ���. Le' 6-
--
Municipality _T,� -e.� .,,Watershed.,
Date of Pre- Soaking Date of Percolation Test
..HOLE
NUMBER CI= TIME' ' PERCOLATION ' PERCOLATION
Run Elapse Depth to Water Frcm Water Level
No. Time - Ground Surface In Inches Soil Rate
Start -Stop .Min. Start Stop Drop In' Min /In Drop
Inches Inches Inches
1 ... .
2
3 N5E'Lr /V -fTio �.V-&D °�C�aL / �iC.ci . /G',, --,;
4
1
'
2
3
4
5
1
2
3
4
5
NOTES: 1. Tests 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 froin top of mole.
rev. 9/85
e
3
9'
10'
11'
12'
13'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED, .
INDICATE LEVEL TO WHICH WATER LEVEL, RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: Dom:
'�. DESIGN
Soil Rate Used (G- / Min/1" Drop: S.D.: Usable Area Provided 6r"
No. of Bedrooms �— Septic Tank Capacity / ysb gals. Type
Absorption Area Provided By L.F. x 24" width'trench
Other A)y ,,T.e
NEW ..
Name 2 i.e.J �`��� Signatur
Address % Z ��•Jc y 4JA y' S
ar
r "
a6 0 �C Y+ l cv
Soil Rate Approved sq.ft /gal. Checked by Date
. _ OOU= . DEPARnM ;QE :HEALTH
DTVISIIX? OF E yIi2G�PIFNTAL HEALTH' SE�Zt7iCES
DETh,GHCU RE`.a1DtliT1Al� Csfu61.0 FAM1Lv'� ,
' DESIGN °DATA SHEET -SLW- UFACE. SEWAGE DLSF?OSAL SYSTEM' FUZNlO.
-- 9(.;MgriM�STRCeT
Owner':LEAE2MA11 ARCH - dr3lcESS' $R WS'j� ��l 10 09
HAVICAWD
Located. at . (street) SIZ I �sToNC 1f tt"c. "-RoA,D Seca Block
Undicate bearest . cross street)
Maraca TA TE25o�t ' Watershed Gino o;,
pality.
T
SOIL PERCOrATION TEST DATA REgunm TO HE SUBMITI!ED WITH APPLICATIONS
Date of Pre- Soaking 1 I es-1 8 .... -.. Date of Percolation Test 1 l Z s
L-OT .
;, . TIl ....... PEROC�IATION pERaOLATIC}N .
Run: Elapse Depth to Water'From Water. Level
No Time wGround Surface, In inches Soil Rate
ate
Min. Start '. Stop, Drop In`. Min/Xn Drop
Inches'. inches... Inches
"
5.x-7
3 ...
1
2
• 3
rt.
c .
NOTES. l.' Tiests lto be repeated• at same depth t :'appzax rnately ` 6q%jal soi]: rates
are l�tanecl .at each percolation test hole. A].l data "
to' be submittal..:
for• review. :..,
2. Depth ireasurements, •to be made fran top of hole.
rev. 9/85
Name }�Al.l�o t- iA LAkaiza- " �•C. Signature
Address -78 . FA i iz r 1 RLr> - 7 i21 YE - . SEAL
z UA
lVV
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,
C
' 'TuRSoN�
THIS SPACE -EOR USE-BY- HEALTH DEP,ARIMT' ONLY:
Soil. Rate Approved sq.ft,/gal. Checked by
Date
- WIN tm rebruary l d, j9_&
8/84
PUTNAM,COUNTY_DEPARTMENT.OF HEALTH.„
„
Division' of Environmenta -1, Health Services.
AFFIDAVIT CORPORATE'OWNER APPLICATION
FOR RERMIT`A0PLICQTION SUBMITTED TO
PUTNAM'COUNTY HEALTH DEPARTMENT'''.
TO Commissioner
of Health'
In the matter of
application for:
,
_ d�
i�.. B:rian R.
DPr
represent .:that I 'am
an 'officer •or: employee' of the 'corporation, and am.`authorized` .
to art for
1ni cnrri -7ndu tries, LTD.
'(Name' of- '.Corporation)
having offices_ at
•:7 - _grnerate .Drive -
r
Y
:
Peelrskill �:. Ny.
Whose officers are
President Paii1
F_ Guil laro Mill. wood-- Rd'.�,- C- h3ppaetua, --NY
- -r- - -�. _�-
(Name and''Address')'
Vice President
Arran R. Dyer 1 2 -Gedney Way., White Plains, : NY
(Name add"Addre.ss)
Secretary
_ _ _....-
(Name and Address)
Treasurer.
-
(Name and Address):.,,.
and that I am and
will, be individually responsible •for.any' and all' `acts'of the ;
corporation ;with;
respect, to the.approval:r'equested.and all subsequent'acts relating
thereto.
:..
Sworn to before-me this :.day Sioned: _
o
of Ii'/A .,.
19d� .' T`itle:.' 'Vice- President .; .
N?% r Pnhl it
- WIN tm rebruary l d, j9_&
8/84
APPENDIX B
PUTNI 4 COUN'T'Y DEPARTMENT OF HEALTH - DIVISICH OF ENVIRONMERM HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE S3QGE DISPOSAL SYSTEMS
ewei1�r�' REi IBV SHMT - CONSTRUCTION PERMIT
s(f� , DATE RE=E- i- D: 91!�%D
ON l IjU D. L TA BY:
eo,Pn
Gim -ne of Owner) ( Street Location) '
YES _j NO DOCUMENTS G'• !�
Pen-nit Application u�
Corpora te Resolution
oar Plans - Three sets s/s
Engineers Authori zaticn
Design Data .Sheet (DDS) S-UMIVI.SION
/ ( Deep Hole Log Z.
j I Consistent Perc Results (3) rFi_1
Perc Hole Depth c3
I
13o' Plans -y.T� O Se ±S
--}-- ar�ancn west
Legal Subdivision
Subdir_sion Approval 0-e ',ad
✓+� -}-- Mc-a_ aroval SSDS Adj. Tats Ciecked
Wet' and (Tcwnf JEC Permit & D)
{ Data On DDS Plans & Pernnit Sa�T�
L .trench provided CJ I. REQUIRED DEMJZS GN,PLANS
o" Sewage System Plan = (north arrow)
ft. max. I ) Sewage Syst,�n Hydraulic Profile - Gravity r ^low .
Parallel to contours_ - _I�._ -- - :- _ -_ - -- - -- Fill -- r file -&--Dimensions
D o J Box; ranczjGallery; Pump Pit veils
Septic - Size, Detail
Wel Detail, Service Line if over
S $ Construction Notes (grinder rate)
Design Data: pe_rc an
TWO -r ^oot Contours Exi s1:1rig-T Fro-omed .
Driveway & Slopes Cut
Footing atte_r,Curtain Drains (discharge OK)
Pero & Deep Roles Located
FILL SYS .S. Representative of primary and expansion
claybatrier I Expansion Area; shown; gravity flow,saff. size
10 ft If .Pinned Pit & D Box .Shown & Detailed
fill/notes House -'No. of Be3roans_::`
n oec, Wells & SSDS's 'n 20 ft. of Proposed System
de ,*h aau es - --
-- ouse a c, .,.Necessary (Tight lot)
House c .. _:, ,1/4 "jf t. 4110; Type pipe
100 yr. flocd,4ev. No Bends; Max.:., Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Drivewway, Large Trees, To' of fil
20' to Foundation Walls
200 ft.. reservoir, etc. 100' to Well; 200' in D.L.O.D, 150'. pits
100' to Stream, Watercourse, Lake Unc.. expar:
150 ft., trigall/gall.0C.Jto 15.' to Drains - Curtain,. Leader, Footing
351to catch basin, st6nrdrain,pined watercours
✓ 10 to Water Line .(pits -20')
.50' int mdttent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' We'1 to PL 9
s
J
Q
Z
J
LOT S
AREA = /. 548 AC.
"T4�is is to certify that
the sewage disposal system was constructed as indicated on this plan and
that the system was inspected by me before it was covered over. The
system was constructed in accordance with all. standard rule's" and.
;.regulations of the Putnam County Department of Health and the New York
State 6--parbrant of Health."
S�EOF NEW y`�
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v�
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Putnam County Health Department.
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Health Servic
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Putnam County Health Department.
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