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02143
1 .PUTNAM COUNTY DEPARTMNTOF HEALTHY "
Orvrsron ,of. Environments% . Heig/ih: Seivioes, tin% N :Y 1061,2 Permit
s.
CERTfF,iCATE 'OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL '
Town or, viilage
./i
Located . at ,i•f�s' -!1 c (! : ' s t^ `p Block
i ,.. Ma
Tax
-�
i OWne►d4 . !; - >' 6j Formerly ° r - - Tax Map Lot $ t• ���.:�� Subd Lot -Y - /•L� _
i r 7:J4
a ySeparate' Sewerage. SY�em _built by "��� �r� � � �Z � �'Adtlrets � ' y �' �%'�'►�7:' - %� ?!! �'"�"I :N 7.
tir t`ya a r Consisting of 'r`C' Gal. septic Tank andrt�
}�r+',�vr9" +� !" yar 7 rw'M v e 'N-� !f.° s) t;{ C
Other requirements
Water SuDPIy t- P blic supply From
L r;
v ti i7� /•Private SuPPIy Drilletl BY
a>��,••� &'t �?� ti-n 3 <� "''J+ �s � "� h- +a t"�'c L a. 7 -r S: s y +�,.
Building Type ;No of Bedroom s Date Permitslswed
,4 Has Erosion Control Been Completed? r "y
a f
,,.1 -? t
�{de��tf.q� u s fl
P I certify that "the systems) as listed serving ttie above premises vere�c ns t °of.eIICi@ll shown on', the plane of the comple£ed work (copies•
r.of which are attached) • =and in,.acoordance with the standards, rules and re 1 ion° Q` with'the 1;iled plan, and the•permif'iaeued by the
r Putnam County Department :Of Health ° cf 6� r s o i ,s
I � f '�s= , -4 t •� r -�' �. e' j, h j %�y�y'1}�'JypC�Q,' j / ..
Oats �� x a rtif ied DY - c s ; PX. Ft A.
} +
'A cc �` laanw No
VVk,.. a �`'b r - ' • Z r :. ' . -
k Any person occupying premises served by the bove, systems) shall promptly`ta(Ce such,act r 49,6 aQry to secure the torreotlon of ,.,any unsanitary
Pt � +
kzi eonditlons resulting from,.wch usage 4gpproval.ofytho separatarsewe ► age systelb°come4tu p void �sYsoon ass rtpublie sanitary aWe1 ti�COfrlas
k;avallable and, the, ±a f
• „ , ppioval =oi the'private•:water.`supply shatlbecomecnullkandj ,`voidhefrtaubtiCr(#t lypicomes wellibN:! Such approvals' are '
; X sub)eet to modification or change' when in the Judgment 'of 1h Com ner �f Neal h; tueh r oatio , motlifleation or change 1s necessary.:
( R^p ..f,�4 t N'Y P� �� iei ? •w'� . ...,'L .kj t •.. r � 1! t' H�L'Y 1 ( h : 'S� r ,�. S �"{ -+ ..
]] '��s•.ca.. ao_et>..w ..... tr � '" �? tit;. � � ✓� to 'xk�`�,�i�'i 5 3'k t7 �} P ;,li,_�1. :tin .t
BREWSTER LABORATORIES
Bolt 224 - BREWSTER, N. Y.
WATER ANALYSIS MEPORT
SAMPLE NO. 5503
SOURCE: Augnle FiOCCO
Richardville Road
Putnam Valley, NY
COLLECTED: August 13, 1984
BY: Mill Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Well
This result ixdicater the tourre of the ran, ple was
of ratirfactevy tawitasy 1wality whim thf .'sample was collected.
August 220 1984,
O per 100 ml.
l�
Bickwit P. E.
Dtrectoe
'" CWTRY G3FF4CX
• �UFILETIAtG - CArtMEL. NEW YORr.;
• .. This report is to be completed by well driller and submitte.e to County- Health Depa:tme.va toter witfti 14*or,atory report of,
a- nalysi;of water sample Indicating watevis of satisfactory bacterial :qua-lity Before ceraifica&®f con =tnrCtioreT'tEOmplianee'is issue.
REPORT MUST 13E SUBMITTED WITHIN 30 DAYS OF ty£LL 001NIP,LET10• "4' . I ..
- -
_
'NAME' -. .- .- -" -- . -• - -- `---- ....�..._.. - _
aDDaESS'. • -. . , ,- , , r.. _ .. _... -. - - - ,.
oT41KEt
Augie Fiocco
Richardsville Road, Putnam Valley, . NY 10579
tOCAtTON
JNO. a 41,06f) (Iowa) 1LOI ti✓mo01/
Of WELL
Richardsville Road Putnam Valley, NY
30
BUSINESS
►tQ►OSED
a DOMESTIC Q £STAG ISHMENT Q FARM 0 11fST -VAi L
-VS1 Of .
y
�,.
Q INDUSTRIAL Q Q
ONIYIONINQ SUPPLY (Spaidd,
ROTARY L= A R P COMPRESSED RCUSSION L.l 'PERCUSSION Q
EQYIPA►ENi
tJ •Or��.
CASING
DETAILS
LENGTM (1001)
501-91,
DIAMLIVI(Incnes)
6
wNtrMT PER FOOT
19
{� •'
a "' THREA00 Q WELDED
to =vE.SHOf�3 �A ING G_4U ciZD?
n x 1.ES jDNO,', YES LINO
YIFID HOURS
TEST Q FAILED Q PUMPED a COMPRESSED AIR 6
WAtER MEASUR; FROhi LAND SURFACE— STATIC(SPOCIty leery DURING YIELD TEST !M•N)
tn= 40 365
0
MAY E -
SCREEN
DETAILS
IF GRAVEL
PACKED:
:1011( ►EOM LAND 5'JIFAC;I
FEET to FEET FORMATION DESCRinioN
0 10 Clay & boulders
10 38 'Hard fractured bedrock
38 365 1 Hard grey & black granite
If yield was istrrd of dine•0n1 depths during drilling, list below
FEET
GAtLONS PER MINUTE
200
3 -3/4
300
4 -1/4
365
30
8 /66 /8 „4ruIto O,ST�,prj IV, rir I.vC:
,.t
30 30
&'Tt b.T :s,tbnyl *fit§'iSic'�etsi Y
W aistaf brTisw tond'sretiia =r. 365
�`1'.:Viti7Tt 010FN TO A.^ruIFEL :;r ••
Wometar of vlail including GRj1b�1 `StZEtiacnes)'r.fachkpaet) TO
grovel Foci- (in:AOsp
T - skstch *Tact tocOffibrl.pt•wO WIM C'istaVSca. to at Isast
two p*rtrse*at Iffl= tarts.
s �
l i
I
rlq JGQS V r� C� "pd
,Pres* -MILL DRILLING. INC.
r f^"
f O
0 er;�d P "iarse �'of'�Buil'din Section
Building Constructed" by " c} y a, a Block
Z
Loc Viori .: treet r.' Lot '
:, / _
Munic 'pa•3'i 'ty .' Su b4l vk's: i oriN am • i
Building T pe "' " Subdve Lot
GUARANTEE 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 guarantee to the owner, his success-
ors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate fora 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_.systeme
The undersigned further agrees to accept as conclusive the determin-
ation of the-Director of the Division of Environmental Health Services .
of the Putnam County Department of Health as to whether or not the fail-
`" "tire'of "the system-"t "o "`operate was caused by the willful or-negigent act
of the occupant of the building utilizing the systems
Dated this day of i'( 19� Signatur
Title jV P t 1qC-.(
Corporation ame if corps)
Address
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION 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
• .."fig ,' y
w S .%• > >...�:, ) k r..r .•x "
-er s..7""`,Y.v,i 9 -
'�� . PUTNA_M COUNTY DEPARTMENT OF HEALTH PeiLtlt a' g'
L er. 's3. a,s2ir t`
Ofwsfon of Enwronmenral aHc�alih Services,p Carmel N : Y 10512 s
�� n rCONSTRUCTION PERMIT A ,OR SEWAGE "DISPOSAL SYSTEMt ¢
Z-,
mown Or i lage
�� < ' ✓�� w<if✓oY' ;.�i,l+ // -i"..w ' .Block �� Lot.:
i i orated at ' N yTax
Ma �fl g ,!
/ J P / J
C�
Subd Lot N Renewal ❑,• Revision _ ❑ _
- .. -
� y.
Gwner /Addresaj% % d T�OI / �� - ? Cr��jf,/£'".s' ; : Date OPyPrevious�Approval3
a
Building Type Ka Lot Area r /� Fillsection Only ❑
-
"
7,`�yNUmber'Of Bedrooms' �k t,Deaign Flow G /P /Dr m �- 4.��'t`8 ''' 'ry' H' D otiflcatio Required' '`�
/bG
7 beparate,:Sewerage: System. toy consist of ; Gal "Septic Tank :
x•
yz To be constructed by ``- Address ' s
`'- > Water SUPPIy l> '
.r. uF
rom
�r t > s �� �S� � •t }� fir' yt c*��� 'e. �y,s +* tY� + �: c � r "'�
r
_1Y .A6
.Address c ,, , K...'
n s Other Requirements
I represent that ram wholly antl completely responsible for the design'aridrlocet�onx of 4the proposed asystem(s) I)r` that the separate sewage dis ofal dysteni
3 1 above described will be constructeC as showri,on theapproved amendment there to and'in accordance wiEh the standards ,rules'an regu a ons o e Putnam .
+County 'Oepartme`nt of .,Healthy andithat'on compietion`iheebdf a .Certificate.- of Construction Compliance satisf6ctory'jt-no the - Commissioner of Health will
R 3 `tie submitted to: fhe Department d:_and'a',w Itten'guarantee ;will beYfurn� shed the owrier, his wcceuors,.h as?�"5 y the builder, that said builder will' .
:place In good 4operating conddion any part of said sewage disposal `tystem - during ,the peiiod of• tw y.fifdY�p °,tSly following ahedate..of, the issue
ante the approval,of ;the Certificate of: Con;tiuctionr Compliance of the ;original;system , or any s t�te►Retop2't �, e' drilled well descr( bed above .
will tieaofated ss shOWn on the approved plan and"that saitl well will be,Installed in ccordancekwith ?sae ° Qr��l��iu_a�iOns of the• Putnam -
i�� yCOunty Department, O .wHialth s v i cam} { - { z qp s V
lay.-
wr � � ; r } � Adticess �; L�L�►s�' No �e � .
APPROVED FOR ,CONSTRUCTION This approval expires one yeai from the date is '16ss �I, uct�o, the buil8�fq�7ias, been _ uri ertaken,'and is,
r-_ ,revocable for cause or may.,be amended oi`modifletl' when considered necessary by the` ommi ion�i °,„e�jcfed �6r: alteration of construction
requires a` new permit Approved` for disposal of domestic �sewa e and /ori rnrat _w r 4y�'
r�`""�.'� 3a >+' t° / r r � � ..� � � � 3+' q$ a+' ,,, s S I� � °o•° o °.�° ��� Df� T , S- a
81,
ReV 9 :a`..+i«.x +�,.. ry K ` ''` ;� a =.. ^., s4 `r�%^^,i't�yw -fit t fi k�'E' k .x� x �� , c '. a ♦ .
> �+yvx t w •h''. r �. T' a, ..^ 3 .,.'Yr.',}`.e Jn�.�'a. .. �.``7 „v "•_ x' 4`i.., .�C "x..� „�'... C.- x.. } �, s. •} i, a
d
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- _ .... _..... �... „�. Date
Re: Property of 1),A44;1
v
Located at /� t�e/�;1 Ca G
(T );/�� f P� Section Block Lot 491 j
Subdivision of��)�
Subdvo Lot Filed Map # Date 9
Gentlemen:
This letter is to authorize z �y r'E-1
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- ' systeiris '- i_ri'- conformi "ty-'with 'the 'pr "ovisions of ArticTe' :145 'nr
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
12
Countersigned:
PoEo, RoAo, #
2972
Address
Telephone
tp'o
�a
'0. 24836 �'a
0
e
Very truly yours,
Signed
!sE% • • . -
w
Address
Town
r
Telephone
3EP 3 1933
e6ij°rit
CO
U Ai'1�
F_
' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_ TY_:QFF,ICE BUITDING; CARMEL;..- N::.._;Ya:_
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner /r r�14 r � ,ter- ; rye- Address %/� -^flaw Al y.
Ir
Located at (Street e9;C,11'"W,? J' -ved Sec. Block f Lot % ,r%
�Indicate neares cross street)
Municipality ,,,4A,1WrW Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
oe
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
No. Time
Start -Stop Min.
'Depth to Water
From Ground
Start
Inches
Surface
Stop
Inches
Water ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
5
5
1
2
3
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 from top of hole.
G.L.
6"
12"
18"
24"
3011
36"
4211
4811
5411
60"
66"
72"
7811
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOIL2) E NCOIJN`!'ERED IN TEST HOLES
. -r
HOLE N0. HOLE N0.
8411,
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED`��'
INDICATE LEVEL TO WHICH WATER, RISES AFTER.BEING ENCOUNTERED
:....TESTS MADE- F,Y .._..... _ _ V r Y7' Date .... -.
DESIGN
Soil Rate Used "Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity jtr l_. Gals. Type_
AbppA�SOrption Area Prov d By L�sF.x2f4 "_ E�h trenc
�v� r
b 1_" -j I, 1.) V t.N bignature ff. "
a
s ,y
Address Z-97 ?_s P :—e c= VI-_5 �-- �- ,� •,. 3
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ` , rev ee 41
A d 0'000000
4ae "ESSIO ,
Soil Rate Approved Sq. Ft/Gal. Checked by
X,1
SEP 2 3 1933
PUTNAM COUIN . ;.Y
DEPT. OF HEALTH
Wl .-A!
-'00,0j, a 1214'
Ole-
.4
A
,P'4t LoUntY Dep
Dlvj lon ojlaM f Envlronmol