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02149
PUTNAM :COUNT'
Division of Environmental
CEFMFICATE OF, �CQNSTRUCTION_-COMPI.IANCE 0,9k
Located at v -" . J —
04" 1.�`V 40 C
Separate Sewerage System built by VA
ti
Consisting of �'b Ib Gal. Septic an
' Other requirements �` - � '��
Water Supply Public Supply ;From,
. Private ,Supply rilied BY v1
jam.. x
3 Iding Type •
Has. Erosion Control Been Completed ?.
1. certify that the}system(sj as' listed serving the above premises were -col
attached) end•�ih;acc, rdance- w.ith. the standards; rules and regulatior
�4
Date Cerrifi'
4 '~ / ski <• -.3'
Address k
P
Any person,occupymg premises served by °the abpve systems) shallryp
;conditions iresulting from such usage '-ApproJal` of the'separate=Se
"available -and the; approval of the private water supply shall become
`' 'subject''to modif.icationr:or change= .wfien, in ,the judgment oC, the;it
e L ;
Date
f Y
Q1
ke .such'action as maybe necessary to,.secure the correction of. any unsanitary
tem•shall b
ecomexnull and void as soon as a'; public sanitary sewer becomes'
jid,when a.public:wat becomes available. Such approvals are
r• of Health; suehr•ce cation, odifiication';or. change, Is. necessary:.
C e—+
.... .
LIMNOL O Y A`T16 N AND FR WATER ECOLOGY
A W
REPORT FOR MONTH OF Z, o
�I
C,4 U c � LQ� - ' rae4R
i 6c OY AYE cOLECTED AYE R�CREYE® .., . DATE .VZED
Q
W0a ftY RcPORT 0 T "VT
P
The arit.` tic nkeen of all standard samples examine9 per 8h usiwg. the pine MEM PA19 FILTER TEST
filter t nphniq� shall not exceed one colony Or, lAbp :` `coliform colonies pmr
standard.semp a shall not exceed 3/50MIA/10001,7/2�1oor WNW in (aH tq® i%�
cot18ec9atI "e savlesm (�9ore than one stand6rd sample when lets'thtass 20 are GA-
COMM
mined 0 wonth;Cc)Horethan five a 01he 0*10s tahen DPeSter than 20 are exa�it�edf colifore colonies /lOOAll
t COLOR -t3Y ®EYY.,:; ODOR . DISSOLtEO
. SKIDS
s,
fiBTRflI'� �S NO2
..,_ b %TRAt� $S
R03
Qld %�,,�5 rdii3
S AS cl
W
L
old %Tl' ' i4S' CaCO3.<.,......., �_...,....�.w..�....�...,..._.. FLUORIDE A
S i'
w
MdtAl, %liflTY AS GCO3
P9pffAflA4e
HgA
YOTAB. WM
ESS, .,.._..,.. .
RS Ca•�� •- --
ELI, AS fe
R9 /L �6
FiR1iWESia AS M
....
AS ABS
MOA
.. P1g /L
This is to certify that this report is coouae9 and
.. . ........... ...... .......... .... .. ...
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DIREM, DIVISIS $F
uMRONMMTAL Hgft SUMW
kOWARr.).-.A K .� Ly lj\�.
CkRMLL) gvw�091K,
CAAW*k' MFW volilqK
17-his ?aporq h Ic be Zomei�pu'-6' bV wA' diliNa-, Pvc? G'u'bn'kv" erg �D'mjai'i 4e, rapan U1
anmgysh 'If t--I�'qtex "Inpgs In"Hwim" wP_"';F.F 13 'vf wr;Wick)14T' of • m;wIk-.'w o;'
James Robin Gal-vano
09 M.fM Dicktown Rd Putnam V.11
ArMWO-4
Mount Vernon N.Y.
�y Pd2
piul-ar mm .71 r
MAW t"N
IPT-A 9140M kAUD VOW
Da WUW41*11
.7.
0 3, overburden
120 lede
�J"W 'wan Gmv-xl —kn4—jtI.
He
50
A
Art Weil Boyd W
R. D. 5 Route 52
Carmel, N. Y. 10512
1 4 Y
Mr.
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MWT
LyJ. AM PUICIMSION 1'K'Ojssl4.w
,ASP (WO Ilk
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LXI Ef, i g
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19
U 8
20. 20
bIUSURE ?MW U'N�- DUCK% 0, 'q MQ
Itotal
drawd-own
60 6alaw tnol suftm
120
piul-ar mm .71 r
MAW t"N
IPT-A 9140M kAUD VOW
Da WUW41*11
.7.
0 3, overburden
120 lede
�J"W 'wan Gmv-xl —kn4—jtI.
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50
A
Art Weil Boyd W
R. D. 5 Route 52
Carmel, N. Y. 10512
1 4 Y
r-
Owner or Purc aser of ui ding Municipality
(�\MrN
Building Constructed by Section
Location - Street Block
P%N C' k-k 2-)>
Building Type Lot
GUARANTY 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 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 -th:e ' sys'terri to,-operate was caused-by the willful or negligent'
act of the occupant of the building utilizing the system.
Dated this 71_ day of 3 c 19j�5 Signature
i3u i V'.
Title
If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP_�ETION 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
LF Y
CONSTRUCTION-PER
Located at
Subdivision
Owner-
'Building
Number of Bedrooms
S,eparato-Sewerage ,Systert
To be rconStructed by
Water Supply
Other Requirements
f "represent that 1 -a n wholl
above described will be cor
County: Department of_F
be, submitted
to the Dep
`place '1' n` ,,good operatin
ance'of the aoorovalrofia
_APPROVEb FOR`CONSI
•'revocable for cause` or ma
requires a ;new ermit
b.
{ Date
Division of En Won
NI
he Supply From `=
ate Supply to be drilled by,
ress. '3
id :completely `responsible for,the desii
cted`is shown on the approved,amen`d
.h; and that`on completwn thereof a��
and.'a• written'guaraMee wi11
itwn_''any part of said sewage: ' ispc
r KxSig►
dtlress L
N C �
O This approval expues.:oney
ienaed or .roodified.when consi r I.
ed :f _ disposal' Of domestic`s n
By
z
DEPART11�E.- ; OF REAL' T]H-
Health. Services,' Carmel, ;N.° Y _ 1Q5_L12 \_
TEM �l A _- TMR�1+�r Y�etn
Tom or Village
Z' 'Section - - Block.
Loth 3 S 42-,
�aas�?9 /b ► a 01
Address ZZ . P�Q� C
r
Total "1Hiibitable Space Square 'Feet.
alSeptiCiTank ® lineal feet X: width trench
ti
11
ntl location of the proposed system(s),1) that the separate sewage disposal system
nt there;to and ;in accordance with'th`e standards rules and regulations of 't Re Putnam
rtificate of Construction Compliance - satisfactory to the `Commissioner Of Healthwill }
rnished, the owner his successors, herts'or assigns by the builder, that said .:builder will:
system`durm e period of tw.o 2
g ( )years immediately :following ";the date of. the issu -`_
Hof theforigma s stem:;orany.re'p airs fhereto 2 Oiled
_w.ell,descrlbed above
Y
nstalled m ccoidance" with the,.. standards rul Wand regul tions of ' -the Putnam
e a
romAhe ASte issued unless construct LOn of the building-.'has been undertaken and is
ess8ry °by the Co oner'of Health; Any ;change or alteration of construction '
ewage °an r r� ate . supply
,Title L°
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH-SERVICES
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO�J S
Owner J Am�t S �4 01 'VOLY%0 Address 22 oles5l- S4. M} qer hot
Located at (Street 01C.-ktOWN ' a6&il Sec. 6 Block � Lot j
Indicate cross street)
;
Municipality PV� NAM VA Ql Watershed CY CA04 ,
SOIL PERCOLATION TEST DA A REQUIRED TO BE SUBMITTED WITH APPLI,
i ") C
Hole
Number CLOCK TIME
h,un riapse
No. Time
Start -Stop Min.
PERCOLATION PE_F
Depth o Water Water L, wel .
From Ground Surface in Inches
Start Stop 'Drop in .,A
Inches Inches Inchesi 3
2 3" a' 34 b z 9 i9 Z' -�.• 1,
C�8 -1004
N� -
►, ; -Svb 2
IONS.
LATION
1 Rate
n drop
- 3 3:46 - 3:59 g 21 % 2.1
4 3:S�t— 1'0 to 21 �'9 22 %4 z 261
2:3.gu �,
2 ,
Z. z
3 ivt
3
5
Notes: 1) Tests to be repeated at same depth until apppproximately' 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES - "
DEPTH HOLE NO.- I HOLE NO. HOLE NO.
G.L.1
6"
121'
no
:2411t
3011
3611
42"
4811
5411
6011
'y rry
6611
72
7811 A
84
INDICATE LEVEL AT WHICH GROUND\k
KATER IS.ENCOUNTERED
INDICATE LEVEL TQ_WHICH WATER RISES' AFTER BEING ENCOUNTERED
TESTS MADE BY I C-S, SAI. VAN Ae� A Date
DESIGN
Yd Usable Area ---Provided
-Boil -Ra n/1 ",Drop:- S. D-.
No. of Bedrooms Septic Tank Capacit pe M AS-
Absorption Area Provided By
_300 L.F.x2411 width trench.
Oth
AcUrflu A BLi A e It V ij b oignaL ee_'1,.7e_t Z,
Address CN,
r J-^
THIS SPACE FOR USE BY HEALTH DEPARTI/MT ONLY:
Soil Rate Approved Sq. Ft/Gal. Checked by Date
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PRE ST. CONC
--CA
k A- -�5_"r-T It
4,N'
- GRD.IEVEI
13A:C. T
t/c COVER
Ile
N q BLCGG; PA'
OR HAY.. rcV/,07
PER F13RATW
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CLEAN GRAVEL' OR
d�l
CRUSHED 3TONE
sl:
AeS
OIRPTIQ� TRENCH
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NOTES ST VCV%I*WACCORDANC . Ei lAfITH,',TH,t RAGES AND.:
TE 04 R
:SYS W to_"'�o
'bF
(J* A. % Atdii `W-T 6j*'S'V' "TME tf74?_Al COUNTY PEPARTM NT.
ca
_6AC K F'
t Sn�7,10 SHAM- N ILLEO UNT CANSPECTIt!) BY DESIi3i�i
I
T
P
At!P-17,W LOCAL '.f EAQTH M ARrmENT 'I F REQUIRED.
ENGI EFR
X,
n
-WTOCONSTST OF. A, -90,9
SNOT' E GALLON SEFirIC TANK
'TRENCH WITH A MAXIMUM
F T
2-0-10 irt "I F.
7 ly&.S W4 9 ';OF` '--,PEP FOOT.
(!w-
u 0, -TC I/
:PI.
Er/A :7
- k?AL jjy�S_
?�5 -5 9� ?50' 4 F-A DISI _jjjo RADE4 REFERENCED TO FINISHED FIRST
A
FLOOR:, L'EV A T ON .,UNLESS OTHERWISE NOTED. '
A
'SYSTEM, NO
S. D.
�'Atkil_' VN
FOR ME,5. GAL VA�,
A_
j ri. HOW&RD A. KELLY JRi
"p
FEV-
:R NO. By ASSOC I TES (JEWYORK
NO 974;
TAX tA1c t 0`S BLK-No. LOT NO. r
-roWN 60
tu T VAL� _Y
uf mf.ALI� �VAM, . E ��_
77 No wpugi 7 7— " 11 1 1 kic taria?
0 DIVISION OF V
"menNMF.NTAl IMAITH SERVtlU
4
998
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