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0"M d Dt"bom ew sift Sliwm& ON" N.Y. Ion'. M spit W ltai�lt 1
w !S OF 0011 MAXIM .
gi _ 1`7
anew slaw . � . � <r� � .v�r57, -86 . � •
Town 'of Putnam Valley,
ot.10 -Waterfal�l��ane •
srdiewe. Nib Forest Park SOL rc 10
p,mWAff�N„�aDAVID & JUDITH DeSTEFANO
_X_.o
Data d Pievb„ Appovd 8 % 4 % 8 6 & .10/ 20/8.7.
mo Addriam c/o Noviello,. P0B 863, «.:..:;.:::.. ,'.:: Tewa Mahopae 10541
I4
Date Subdivision Anuroved 11/1/76. Fee Enclosed ❑ ' A,n ,,,,t
y T 4 Bedroom Res'. De Am 7,363 aeres FM
le d d Daibe�e 4 tLt�r. Fim G.. P D 8 0 0 PLC N.dM%dw 1s Ypvked Wb t M k cawbtad
gsewe o boaft 1 ��n a.._��a" 572 ft of two foot wide trench
�
Addlees
Walla, Swalbt ai.ao., S"* PYe�e Addnaa
exist g M@Svpy,WWby_.Bie,le •ate... Rt. 6, Brewster, NY
otr.e Nestig�e.ta ..
1 nwewnt -..thai 1 am wholly and cenpletely msponoble.for the desgn and location of the proposed system(q i 1) that the seperate. sewage• diepOsel system .
above described will be constructed as shown on the approved amendment there to and In accordance with the standards. runs an�pu M
Dowdy OepNtment of Ma.t :and that on cornpkifk MMIWeof'a °C"ficeti of. Constiuctlom Compliance" eatisraetory to the Commissioner at Meeltliwill
Ile admnMed to the Oepertritint. pad a written gilarantee, will be furnishdd the owner. his weoaoors, heirs or assigns by the builder. that said butler will
owe in flood .eperatkig oondltkai, arty pert bf. aid teWije dkoosal SV94M during the period of two (2) vows Immediately following the date of ter kau-
amoe of the approval of. the`Certtfkate of Construction Compliance of the original system or any repairs theretol 2) that the drilled well described above
WIN be kwAled as slaw" on the aop►wad plan and that rild well will be install4gl.jp acooMMnoe with the standards. rules and regu R of the Putnam ,
Couaft pia7su;t of F WIL ,��I1
Oaa — • Signed P.E. X R.A.
Address Rt.:9D.. & EI tins Lane, Garrison,, 10524 �ic�nse Ne'061145
APPROVED FOR CONSTRUCTION: Thil approiral expires two yws from the date issued unless construction of the building .has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commission of Mealth.. Any Mange or alteration of construction
requires a new permit.. Ap.p o"s for disposal of dorrmlk:.wnkary Morsel. gri0harrPrivate water supply only.
Rev.
`10/88 `
Oat
-
f J T / A
. ��
Owner /Address+tq'r JI-.' �Q- 2:FeI'il
;k +Building T:yp@ 1! :f1fldIn
iNumber"of'IBedroom`4'
Separate fSAIWOmge, System ato ti
�3
� To�be con "structed �byF, �a
Water 'Supply Publi
s -
-ova
a
3m } i-A-
k�ilOther iRequlreme "s '��9' =y
4�/L218 4
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r` P',! TN 1�1s L'OUNTY •DEPFFFXAR?T�MENT OF' HEAL H r TE'aGINM# 1%; PROVIDE ,T
_'PERM4 #`
1` r �ON� CERTt ;CFICA� , 0 CQM _ILI . RUP.A,
�Dtufsion of lE,hvironmenia/ Healthy cSerwces; Carmel N. Y let, RERM<IT � o
Plfll e�ll�yt '`.tElOrr�P;'�Pr�"�xMa: kB'°Qc�XY346"xAate,Of previ'oueA royal _ _ a
� r ?�.: -� 1' �. -.. .s� r?�..;'U`" Y's: �� ,ry::�€ ,
r!e�s is d�e?nt6�IArea� �4�+c r�ers�ei11 Sectiongo,1lyJO'
on
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or15_pletely { ►esponsiklaifordh esignan tlocationtof fthe prapo_fed system(s)i, l) that dhe seafe seNrage- disposal system
!^as shO*,§(on t ie ppr�oved' ent7rn$�iYdhgre.(fo and lin(accortlance withithe standartls; ru es an ;LegU d ons!o e ' u nam' . M
end thatonrcom,glet�on�fhereof ali - ei't£iLicatet ofrCCon``s.r,Le�fon ;Complibnce satisfactory to thei oirrmissio_ne► of Heaithwill
and a w►itten uarantee wGiil Ibe f riCtished `thP ow eY; his successors,,tieirs orxa3signs DY thetbu lde► that isaid b'Widei
many partof said iseWagercdisposah.!systemi d'uiing Rt%e pei�6d;�f ttwo (2) tyears immediately folidwiip ¢h_e?tlate pf.'t_he issu -:
rficate of ;ConstructionlrCo p�iane .tof the ,o_ ►,iginal system q►'a�ytrepaiirs the►efo 2) that the drilled well'tdeseribed above k:
rrovedJrplan, andthat, rsaidtare`_Ilfl�(fielinsfalled? in accoi2afice wif_hr 4hestsndard;:.,rules and'reyu ons, dfi the ,Putnam -`,
Signed _.JM a1(t itjh� e,W J NCO VtS U Oc$ P EX R /4
dress �R;:t r �6� 1P't B �ozx X816 3, 1Mua th, vw ija,� '1 (i jcense iNO T[l fl 1 l�S� - 1
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inge� or(mod�fied when �oniide►ed�negessah� by (the Commi ;signer coi IHeplth 'A eharige or alte►atlon of construe`tion:
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3 1 ctpresenF that I am Wholly ar�Ld' completely respor1s161e for the desgn.,and IOCAU00 cOf the p►opofed systems) ` tMt the fe - rate fevvaye dispostl iYstem
f v .aboYe.dKC_ritHd .Willlbe eonstctleked,assliow..n on thoepproveQamendte�ant the►e to and!ingteortlanee'with fhestana rtls, rules;a _ repu �ons.o_ a u nam
aft t�oiiotY Departmant.:ot' Reelthi, aAd tftiton eb711gletianr .`thereof, +i'wG'ertifiiite, o� anst ►Letioni Cortlpliadee” fat(itseto ',fq;the CortimissiOn�i Ot.}1Ntth +Will F ;u
Y ,a submitted' ,to the: 'Degortmi"t, anit a' written glriranteb 'wiU l nt !bY the „Duikla tMt aid bYlidr► Will
aC plece in yawn opadtltty eond.(tlon anY! ,past of aid lewayp dispotal �systetn' fluriu9 the ptr,Iod of, fwo „(2) years'immWytely„ folkrsdno the date of the luu-
yams of +tM; 'apMOV7t6 ,eff' A t ,Gertiflut' rQt 600n11i4ita►U;ComplUnce ofs ttf e::(Oripiliil rs�stejm'+o'I my fs!pii!sAthadEo 2) SMt, tM,;p %ItNd, W111;idpseripeq 'above -
a'^
WHf be k►cated iat drown on the appY od,ptan aj�d''tMY saM wHl wfll "tie': Install, ' in atra de vvkh the standards,. ►uNf and re�u a -ons ot'.- tM utiram
��r ",� County Dadartment of,� +ROaRIZ:- •; , . � r
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APfPROV,ED XQROR tCSONS$RUC -T V4- ;+Tthi'f t ',Or6vil:oekti'Uei'l ro is:'ir, m,L ie" Biter is ued tul les rcohstruetion $1`,,the builginy rhas beep unde►takehq nd pis, „ ° �,
._ — - -
�j ►eivocabfe,tor cause orisay ba,smende� ;�onmoQl�i'ed vfiien 4on ds►e' ” say.by �t'h, -';` ommisioner otr:Health�'1;Any e6age�or lferation ,oi,ionstructiom
<< �� uiaf i inew�f erinit;` ,Approved Not- �d�sp0f�l�of ,do . e� ' �san'i ` ;,, ,fv � w6ter wppl�y� lonly�,t - ” s: � ,
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PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SE NAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
WE" ...: r�...:....> ..�- .- �......d- �_:- .,:�....;.. BY..' -_:
a ,
(Name of Own ) (Street tion)
CATS YES NO DOCUMENTS
Permit Application
-� Corporate Resolution
Plans - Three sets
Engineers Authorization
x Design Data Sheet (DDS)
Deep Hole Log
r Consistent Perc Results (3)
.� 30" Perc Hole.
Other
Tl-mc K 4f House Plans Two sets
/V4 If PWS - Letter
n Variance Request
M aav�, REQUIRED DETAILS ON PLANS
Sewage System Plan
5° -r Sewage System H drapir�rofi. - avity Flow
? X Fill Profile &Dimension - olume
D or J Box;Trenc ery; Pump pit details
x Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
_ x Design Data
Two -Foot Contours Existing & Proposed
r X Driveway & Slopes Cut
Footing /Gutter Curta' ins
-� Perc & Deep Holes t
Representative o age & Expansion Area
1c Expansion Area;shown;gravity flow,suff. size
- 'If Pumped Pit & D -Box, Shown & �Dgt;Ailpd
i House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
0< House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
n SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25.' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
¢n /V Ex- approval SSDS Adj. Lots Checked
1) 3 Wetland ( Town /DEC Permit R & D)
P�.Uls I I X I Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
. INDIVIDUAL w= SUPPLY SUBSURFACE SBU GE DISPOSAL SYSTEMS
INSP. BY: _
(Name of Owner) (Street tion)
INITIAL SITE INSPECTION YES NO COMMENTS
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 driveway f
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. 1 Lot
Depth to G.W.
Depth to rock
Soil Descri
0 ft.
f
z
to G. W.
cL/
to rock
3 ft.
Soil Descri i
slcr
3 ft.
6 ft.�
1
9 ft.
12 ft.
Slope of tile line and trench acceptable.........
12
D.H.
2 Lot
Depth
to G. W.
Depth
to rock
NO
Soil Descri i
0 ft.
3 ft.
6 ft.
1
9 ft.
12 ft.
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
Soil uescri tion
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
CAS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.......... .... ........
10 ft. maintained from property line and
20 ft. frcan house ..............................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fromtrench ..... ...............................
Boxes properly set .. . ...... .....................
mould surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
?oes lot drainage appear OK in area of SDS.......
—�
FTNAT, GRADNG OF SITE ACCEPTABLE.. .,. .,,
r
—r
' ^ - ^• --+ /` +....el A► Y 7f7577 PF.KMI l M
PUIT�M OOUNTY DE ,A� OF HEALTH
'DIVISION OF EMRaZERML HEALTH SERVICES
A Ira
Located at (Street) We.,I X9211 L.&69 Sec. �_ Block Lot 15.10
(indicate nearest cross street)
Municipality Pj 41)oin l/4' / Watershed
SOIL PEROOLATION TEST DATA RDQUIRW TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking (�/1 g& Date of Percolation Test
HOLE
NU4RER CS=, TIME e m PERCOLATION PERCOLATION
• Run Elapse Depth to Water Fran mater Level
No. Time Ground Surface In Inches Soil Rate
Start Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
11
5
3 D SO 30 2.4 -251/2-
4
r� 22 M ►� / ►�
5
2
3C� �L7
2�. 253
13A8
2
3
0 30
24 25
_3
4
5
3 D SO 30 2.4 -251/2-
4
r� 22 M ►� / ►�
5
1
2
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 suimitted
for review.
2. Depth measurements to be made from top of hole.
0
`o
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.
_._..`OVherWABS DEVELOPMENT CORP.' Address 163 Cordial Road., Yorktown, NY
Located at (Street Waterfall Lane Sec. 4 Block 1 Lot 15.10
�InRcate neares cross street)
Municipality Putnam Valley Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of '
Pre - Soaking 7.1a(, -
Date of Percolation Test � 12.8 la 62
EOLE .:..:...
1444 -S M
CU= TIME 12 5 7
Q m
PERCOLATION
PERCOLAT 0
o Run
Elapse
Depth to
Water Fran
Water Level
No.
Time
Ground
Surface
In Inches Soil Rate
Star Stop Min.
t
Start
Stop
Drop In Min /Tn Drop
Inches
Inches
Inches
30m;" 30
24
25-3/4
13A
2
30 3D
2q
?� 313
13�A
. 3 n
aQ 3o,
24
2 538
1 -lk
4 ..
5
2a 1 6 6Qbi_„ 360,`3 M n L02 7A' i
2 24 2h '1A 2 '%
5 4124 Re-ac Rkf 17min /i
2 - 4d
r
3
5
A Se 10 Tests to be repeated at-same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be suhmitted
for review. to
2. Depth measurermnts to be madr, from top of hole.
ti
DEPTH HOLE NO.
L rush
G.L. par
. —In ,
21 Law (IS uj)
31 LOAM
41
51
61
71
81
91
10,
ill
12'
13'
14'
HOLE NO.
G (L)
HOLE NO.
/-QAH (5ILTi)
Lr)A+ A (sucri)
PF-SeLes 'i
-S&J 6 11 1 QAH
P e- a P, 1-c- 5 £
5.-N 6 11 L 0ALI
SA JJ D Y M
PC GP3-Lzs
5AMD'Y
xMieff" T.-MM72=0 -
• I=RECarl 4AW -4,1CL45: DAII FLY
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS, 14A-DF,. BY Don'ovqn., . Date
z
DESIGN
Soil Rate Used 16-20 Mirvi Drop: S.D. Usable Area Provided 1143 sq.
No. of Bedrooms 4 Septic Tank Capacity 1250
Absorption Area Prov=e By_.572 L.F.x24"- --,!
Matthew A. Noviello. P.E. bigna
Address gt-_ rF PO Rog 863
Mahopac, NY 10541
THIS SPACE FOR USE BY HEALTH DEPART?4ENT ONLY:
Soil Rate Approved Sq. Ft/Gal-
Checked by
U ye concr.
trench.
h
Date
DESCRIPTION OF SOLIS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G. L. 1yostj BROSH
-A,1;� Vj5&Aj&MN yr-,, --rwr �j
21
30 S (I-T-i
41 1- OAM -S Afj b
50 SAD
60
71
88
go
10,
ill
12' 0 0
13°
-SAOip
14'
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERM
'D te
-a
DESIGN f.
Soil Rate Used 16 -2 0 Min,/1 "Drop: S.D. Us4le Area Provided 1143 sc
No. of Bedrooms 4 Septic Tank Capacity 121__1
Absorption Area Provided By,.. �72 1 L.F.xN" .............. i�,
. Noviello, P.E. - oigna
Address gt_ (;, PO RON 863
Mahopac, NY 10541
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Type concr.
-th trench.
tier
.Soil Rate Approved Sq. Ft/Cal.- Checked by Date-
I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
. n_.... v.+ a, r- i...., � ..,r.._er.....,a..af,:c....in.. _. _v .r.i- ....- .n�c <i.n. .. ... .n ,.. r. .. .- ..........- ...a,a., ., �.m... ..�,...�a. v:.:� u.ae.• - �.
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Ovner ABS DEVELOPMENT CORP. Address 163 Cordial Road., Yorktown, NY
Located at (Street Waterfall Lane Sec. 4 Block 1 Lot 15.10
�In7icaEe neares cross street)
Municipality. Putnam Valley Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
I> to of Pre- Soaking 4 _Z_ /e(o - Date of Percolation Test 3La Alm
HOLE
. Z,. W . �
Run Elapse Depth to Water Fran Water Level
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
# ' 1 O 30mi'h 30 24 25 _1 13/4
2 C) 30 '�0 2.4 z5 3/8
-- 3 n - n 30, Z4 2 5 3/6 1 -31f? Z, Z
4
3
4
5 AVey PQk PA-TE 17-m i f) /r
G il'
mUT��M Ccs�,�,.�
5
NOTES: 1. Tests to be repeated at, saw depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be sutmitted
for review. 4
%- .Y+.�.,+ +-r) f-*- made fran top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
N
DEPTH
HOLE NO.
HOLE NO.
HOLE NO.
j
Zrush
1
To P 50 1 L- IL Q&L:j
-0025014,46AM
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21
LOAM (-SILT-Y)
L 104 d L5 IL7-4)
(Suxl)'.
31
L Q AIA Ls I L T-q)
SII,7-/
LQAH
Pr- 6 P, t E5
41
45
54 K) Q Y L OA M
S) 6-1
Y LOAM
(>,E Glat,=-5
5'
5,4 M D -/ 4,6-4 -d
('04M
Pe GEst-S-s F
61
S,4tJDI/ L(-SAM —
Pr- a SLES -f
71
1
IA I\j 0,/ / 0AvL—
S 101
4,QAtA
81
go
10,
ill
12' (Q ROUND r420 /,J 1) 4y Pl-t=5 ti-,,ER6 DUCT
13' FP FIC Par- 6LOC11CI-F, DAILEY
14'
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
T -CH WATER-IJPVFZ
--L -'�TJTV -RISES-AFF!73R_-� BaING, -.EAXCQUNT
T& ZVE, HI
TESTS MADE By R. A. Donovan Date
DESIGN
Soil Rate Used 16 -20 MirViIlDrop: S.D. Usable Area Provided 1143 sq.
No.. of Bedrooms 4 Septic Tank Capacity 1250
Absorption Area Provided By 572 . L.F.x2411 3
me Matthew A. -Noviello, P.E. bigna
Address gt-, 60 PO Box 863
Mahopac, NY 10541
THIS SPACE FOR USE BY HEA112H DEPARTMENT ONLY:
Soil Rate Approved
Sq. Ft/Cal.
Checked by
0
;, ;V"d
Type concr.
dth trench.
"`b�her
Date
X11 l.JA1A 1W UJUU.::l/ 1V I_XU JV1.1'1..L111•.,♦ "_L.LK"1 ['1CrLll..C�11 VlV
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 4
i3 {ush �
G.L.
I _: . .
jk
2'
3'
4'
5'
6'
7'
HOLE NO. S HOLE NO. (D
Brush
[iecn(� i nQ Ile.a.� - :� I crhon Derayit� Veaa-{ -n rhioh
TDPSoIL
LO -AM 1 SILT-1)
Lr)AIM (Sit-T-6
PE [i GLES t,
S&J D y r_QA -M
PF-Be -5 �
S kNO y L QA-M
SANDY Loll-.M
Pe G��,�S
E
AMD Y 40M
8'
9'
10'
11'
12' C- rRcxjmr) _5en_--;�matj DAi err�)F- - 0C_1Cr
13' FR�F�z�yc
14'
r a /►r
PE .c
:iv
PE c
i ► ny L Qij►
PC cc
A.. r.,4
PE r c _
Q'14
Pe cG
QA./
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTE
.TESTS_ .MADE::BY..: _ R. A .Don ova. n.._ ... y - :Ihte
DIN
Soil Rate Used 16 -20 Min/l "Drop:. S.D. Usable Area
No. of Bedrooms 4 Septic Tank Capacity 1250 Gals.
Absorption Area Prov de By 572 L.F.x2411
thew A. Noviello, P.E. Signature
Address 863
Ma opac, NY 10541
Provided 1143 s q. f i
Type concr'.'
---width trench.
NEB L%her
THIS SPACE FOR USE BY HEALTH DEPARTTj1ENT ONLY: ��F�`` fJ`�1]J`•i
proved Sq. Ft /Gal. Checked by Date
PUTNAM 'COUNTY
DEPT QF HEALTH
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION '
v DESCRIPTION OF SOILS ENCOUNZMED IN TEST HOLES
DEPTH HOLE NO. % HOLE NO. HOLE NO.
a .._....._ ._ _...
(3 Rvsrt
VF"ldT.4T(/�aj
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
r wr • r
awn Y l
SAID C
SA�j1)
0 r7"RF fa E f THAcc1 Gy-CLE DA IL"-:7x
INDICATE.- LEVEL AT. WHICH GROUND WATER IS ENCOUNTERED
. __...._.._,._ _ -_. ND3ECA E -BEVEL T1J lnl�l ICH- 1�lATER LEVDsL RIS S _ AF'I'EA::BEING.:-:ENCODUN.TERED
,
TESTS I4ADE BY R. A. Donovan Date J � 'g6
.
DESIGN
Soil Rate Used 16- 20MirVi " Drop: S.D. Usable Area Provided 1143 sq
Ito. of Bedrooms 4 Septic Tank Capacity 1250 Type concr.
Absorption Area Provided By 572 L.F.x24" "r �'�'�
_ ,- w dth trend
Other
.L
game Matthew A. Noviel o P.E. big pure rya ,-
Address Rt. 6, PQ Rom 863
Ma opac , NY 10541
J`tSS10��
THIS SPACE FOR USE BY HEAU.VH DE,PARTM , T ONLY: .
Jved Sq. Ft /Cal . Checked by Pate
Pi1TNAM COUNTY
DEPT, OF HEALTH
J ,-t/-
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
Dlvlelon of Envlropmeutsl Haaltb Servk+ea, Carmel, N.Y. 10512
Eoglaoor Meat piovlde ¢ V— 5 7— 8 6
P.C.H.D. Permit N
,,.-
TE.OF CONSTRUCTION COMPLWNCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley
Waterfall Lane °zownory •
Located ad Ter: Map 4 gl� � � 15 10
Owner /applkantNama D & J Destefano Fo ,,ody ABS -Develop mergtbdl-Aw. N.. Forest Park
Malft Address Waterfall Lane, Putnam alley, NY Subdv. Lot # 10
Fee Enclosedfl Amount Date Permit Issued 10/20/87
SepanUo Sewerage System bunt by Addreaa
: Co,eleting of 585 ft 2 ft- r ncrhnoa Soptic T=& aad 1290 coal on concrete tank
Water Supply3 Public Supply From Address
on XX Pdva% Supply Drilled by Address
type 1 family Lot Size 7.8 acres Has Erosion_Cnnt -rnl Rppn Rninplptpd?
Number of Bedrooms 4 Has Garbage Grinder Hoop Installed? No
Odrm Requirements n n ne
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regul6tions, in accordant th the filed plan, and the permit issued by the
Putnam County Department Of Health. ,
Date April 24 , 1990 Cart {fled by p.e.� R.A.
{
Address Rt. 9D & Elvins Lane Lipner 061145
No.
arri.son, NY 1U524
Any person occupying promises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubs% sanitary lower becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to mod {fl ion or change when. In the Judgment of the Comm {sslbner of He revocation, modification of change Is necessary.
,89 Date 4 Title
L.,....-
... �f /, •7717 T 11A1R'f1T TTTALT nnnnnm
Wr,LL 'l,VrlrLr,llUL4 r<r:rUD6l
L, DEPARTMENT OF HEALTH
- i)ivs3or:�OY-- EriviYOrilaental Healt:H='Services- •' � "= -_-
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
-
ELL LOCATION
WELL
ADDRESS: t"r��vt � I Y TAX Gii10 rounitlEd:
g ®U � °� �, S✓
WELL OWNER
74AME: AooRESS:
-71
P6IVATE
P PUBLIC
0USE OF WELL
- primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY ❑ Al /COND. /HEAT PUMP ❑ ABANDON 0 U.�e
❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED ._/ EST. OF DAILY USAG5�) gal.
REASON FOR
DRILLING
®REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ADDITIONAL SUPPLY
[]NEW SUPPLY (NEW DWELLING) ® DEEPEN: EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL -- - ft.
DATE MEASURED
DRILLING
EQUIPMENTc,
O ROTARY
❑ WELL POINT
gCOMPR-ESSEQ.-AIR PERCUSSION ❑. DUG
CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING IVOPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH b _ fL
MATERIALS: rSTEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE __ ft.
JOINTS: IYWELDED ❑ THREADED ❑ OTHER.
DIAMETER S in.
SEAL: ❑ CEMENT GROUT ENTONITE ❑OTHER
WEIGHT
PER FOOT lb./ft.
DRIVE SHOE MES ❑ NO
I LINER: DYES. 0
SCREEN
:,. -DETAILS : -- i
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FI _
- _ _. _ ._.._� r_
YES- 0 No
GRAVEL PA4
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST
00: ❑ PUMPED
COMPRESSED AIR
O BAILED O OTHER
P If detailed pumping
a tests were done is in-
�
r formation ached?
i 0 YES NO
TELL
LOG )f more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
l
Water
sear-
ing
well
Dia-
In
FORMATION DESCRIPTION
coot
ft.ft
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
3.;u
a5
'
Q;J
,
WATER O CLEAR
QUALITY ❑ CLOUDY
O COLORED
ANALYSIS ATTACHED?
TEMP.
HARDNESS
ANALYZED? OYES ONO
O YES ONO
STORAGE TANK: TYPE
CAPACITY GAI, .
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELLIAIRDIRM WELLDRILLIFG _INC'__'
NC. DATEe 12 p
ADDRESS Clapp Hill Road 3IGifftRE
LaGrangeVille, N.Y. 12540
3169
NYS' FLAP q'fOfOt3 - _ COUNTY OF WESTCMESTEp E- 1,1' Rey. 69 '
OEPARTMENT1OF LASORAT.OAIES AIiD RESEARCH
VALHALLA. NEW YORK1,0595
BACTERIAL EXAMINATION OF DRINKING AND TREATED WATERS,
x L<h,NO W
Lab.'No: ENT. ,, :. Date Coll`d Tlma' '
TIme+Set, Time Submitted
.—Tests (Circle): SPC, ColiformMPN Coliform Membrane, Fecal Other
x - •
Coll.d by ( Agency Colt d for
Coll 'd from; llsme
,� ..{ .. t fir• Iwu f i t r ter nn p- �.
d J tt f Jh�i� fs'rV�
Address aCr::
-. ISr as 1 -� �IGty Ta n vmpp ' . Izro Caeq `'� ICdunbl
Identification'of Source? —
'ai Jtr `yFg i R�fn eraled�
Sampling Point wlthin,Prsmises
ri ted? Yes G N mg/l, Toal Chlo mg /I pH
fit. �S
RESULTS OF EXAMINATION OF: WATERr...
t Y �F • ti
MP_N /100 rtil Staridaid,Pl�ts Courit
`^ Bactena per ml _(18 hr )
Coliform Group,' mi
Membrane Method /100.m1
Number. Positive.Tubes f Totsl`- olfor-
••Fecal Coliform Other `
u t, 1
The results 'indibate sample f(diu, was not) of Reported by
The" bate
satisfactory sanitary quelrty when tM
66 ct)IlaCled
Ir
JOHN M. ROBINSON
d /b /a/ J.R. Construction
Ay
RD 1 Box 349 _
TIVOLI, NEW YORK 12583
(914) 757 -4434
, P OP,UAI $UgM VEO �O •
,�..... .. a ._ « . „ »,,...,.... .._ < .
PFF'iNE "pA•
STREET
JOB NAME 9
79 Albany Post Road
CITY, STATE AND ZIP CODE
JOB LOCATION
Montrose N.Y.
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
This is to guarantee, Mr. DeSTEFANO,for the period of
one year on the workmenship in the installation of septic
system, located
on Waterfall Lane, Town of Putnam Valley.
The design has
been guaranteed.by the engineer.
PUI'NAM COUNTY DEPART OF HEALTH �
Owner or Purchaser of Building Se tion Block Lot
Building Constructed by
S ; s°� 17'
Location - Street Subdivision Name
Municipality Subdivision Lot #
Building Type
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee 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 approval of the
:__uCe�tificdte cif -Cons, uctlon- Compliance" for the savage= 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 system.
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 the building utilizing
the system.
Dat this day of ��i 11 ;Z Signature
Title
eral Con actor (Owner) Signature
Corporation Name (if Corp.).
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Address
COMPONENT
OF' HOU5
A rB
C
SEPTIC TANK
49 28
1{y.
PUMP TANK
60 20
DI ST 80X
96 46
TRENCH 1
33 49
TRENCH 2
38 51
TRENCH 3
4 1 5.6
TRENGH q
q6 59
TRENCH 5
52 63
- TRENCH 6
58 57
TRENCH 7
64 7Q.
TRENCH 9
77 81
TRENCH 10
90 80
I