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BOX 20
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02334
Owner..or PurcFiaser of Building Municipality
Building Constructed by
Arbut',is Street
Location - Street
Split Level
Building Type
1. ;. 15
Section
-`'arco l 10
Block
j.,ot 18, "ec. rj Rocriilp', Brook Lake
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-
-. , vGe:s: -,.of :-the, Putnam :County Department of Health. as to whether or not the
'ailizre of` the` system to' operate"'was ca:us'ed_ by the' wi`llful� or''riegligerit'
act of the occupant of the building utilizing the system.
Dated this 0 day of 6 C 19 Signature
Septic C;ontra.ctor......, Title
(If corporation, give name
and address)_
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP-TTETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - - I - - - --- - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
.Building Contractor....... e ...... g __
l�Aidress /7
r� s oyIr�3t�WLU
S
/
i.
PEEKS!
1879 Crolnpond
w+ nrn rms r�vn
rU
HARDNESS, TOTAL -ppm
;TERGENTS - ppm
NITRATES (as N). -:ppm
IRON, TOTAL - ppm
W
S;
�L MEDICAL LABORATORY
mt
A.* Barclay Plaza Bldg. A, Apt
1 `'
a .' . :.,, ,.s -. ,w•;.4• m .:.*.,.zy. -c- rs,e.:ae vsm.- aii�,w.. a. .a..:m ti w.�,.w r-�? .�.c. �,ZPW7 .+
( w DATE COLLECTED.
RESULTS.OF EXAMINATION OF.W
1
AT ER ' Q •:��
DATE RECEIVED
/N ER" 7
TY;;.VILLAQE, TOWN 6 /UR•NAtv1 OF SUPPLY. DATE REPORTED -'
.MPLING POINT.
�CTERIA P/I� R ML:'(A4ar plate count�at 35 C):'COLIFORM
GROUP (Most probable iVo. /lOOml.)
HARDNESS, TOTAL -ppm
;TERGENTS - ppm
NITRATES (as N). -:ppm
IRON, TOTAL - ppm
IE
WELL COMPLETION REPORT PUTNAM COUNTY DEPART1,1.1ENT OF HEALTH
3171 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
`(his repot is to be completed by well driller and Sut.';.;iitcd to County Health Department together with laboratory report of
IT, Pip" ti t r d, t e : f �u .'EFurelLl l vi }rl: iII",ncc iS GI..� .-.
. ._.,,•'r2iTia9'y513'�� ��' cif! o..= k,. y4W :l):I£2,iiST�.li!3�tt;r:3a�Q •� %!t!`rfiiC•, "i3f` -�:t7vi .rtal.:�4t71! `j..)n {QtrC CC'tif,Cat(: ..C�t ( �ISSti�,s.••• -:a.- . _
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
szeran
ADDRESS
LOCATION
OF WELL
(No. 6 Stfear) (Town) (Lot Number)
Arbutus St. ., Putnam Valley, Na Y. 10579
USE OF
WELL
BUSINESS
®PROPOSED DOMESTIC ESTABLISHMENT D FARM TEST WELL
PUBLIC OTHER
l
D SUPPLY INDUSTRIAL (�
<_J CONDITIONING (Specify)
DRILLING
EQUIPMENT
THER
ROTARY AICOMPRESSE CABLE R PERCUSSION PERCUSSION E] O(Specify)
CASING
DETAILS
LENGTH (feet) I
22'
DIAMETER (inches)
61,
WEIGHT PER FOOT
15 E� THREADED ❑WELDED
DRIVE SHOE
OYES El
V1AS.CASING GR UT G2
C YES. NO
YIELD
TEST
HOURS G.P.M.
D BAILED f PUMPED L3J COMPRESSED AIR 7¢ 12
YIELD (G.P.M.)
12
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Specify legit)
DURING YIELD TEST fleet)
Depth of Completed Well
in feet below Land surface: 170'
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (foeo
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:'
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permsnont landmarks,
FEcT io r%[i
1'
10'
hardpan
10'
170'
bedrock blue granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLEYED
DATE OF REPORT
WELL 61RI,LLER (S'Ignalur )
,,
PUTNAM COUNTY DEPARTMENT, OF HEALTIi
_..___._. __._. _. DT; IISTC f ~•Ei�IT�rI 'e i c 14Tks 41 AE * -&z 1VzK -T-I
Date July 30 s 1973
Re: Property of Michael Deszaran
West side of Arbutis St approxo 555 ft sou .o n e. section
Located at of Pudding Street
•Section i5 Block 6 LotT Map Parcel 10
Gentlemen: Lot 128 Section B9 Map ly Roaring Brook Lake
This letter is to authorize Roy A. Burgess-
a duly licensed professional engineer x 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
1.47, -Education Law, the Public Health_ Law, and the Putnam County Sani-
tary Code.
Countersigned:
P.E., R.A:, # 9845
Burgess & Behr, Pa Co
128 Gleneida Ave*
225 ®3312
Telephone
Very truly yours,
Signe d4 / l
Own &r of Prope ty
141 East-Lake Blvd.
Mahop ag dir s t. 10541
- 628 -8841
,E� Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DESIGN,DATA SHEET - SEPARATE.SEWAGE DISPOSAL SYSTEM FILE NO. '102 -529
Owner Michael Deszaran Ades 141 East Lake Blvd., Mahopac, N. Y. 4,j u West i ., 3g5 of
Located at (Street)of Pudding Street Sec. �5 Block -6 Lot Parcel 10
(Indicate nearest cross street)
Municipality T. Putnam Valley Watershed New York City'
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
.Run Elapse. Depth to Water Water Level
No.- 'dime From Ground Surface in Inches Soil Rate
Start Stop Min: Start Stop Drop in Min/in.drop
Inches Inches Inches
110:34 -10:41 6 22 23 1 6 Min.
210:41 -100-48 7 22 23 1 7
310:48 -10!55 .7 22 23 1 7
4
S -
I
110 :3 -10:40 7 . .21... G2. 1 „
210:40 -10:47 7 21 22 1 .7 „.
310:47-10:54 ? 21 22 1 7 �r
410x54- 11:01 7 21 22 1 7 �f
S
2
3
4
S
Notes:
1) Tests to be repeated at same depth until approximately equal soil rates are ob-
tained at each percolation test hole. All data to be submitted for review.
2) Depth measurements to be made from top of hole.
a '
I
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
- I
DEPTH HOLE NO.1,.29 3.v HOLE NO. 4 HOLE NO.
G.L. Topsoil Topsoil
rr sands ton loam sandy, stony loam
12 y9 y trace of clay
1811 _ _ no bounders
r tP tt •
20!
JO It tt fP I
11 tt 14
4811 it
54 tt 9P
60" �►
72n i
78tt
:INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED•
INDICATE LEVEL TO WHICH WATER LEVEL RISES•AF.T7 ER BEING ENCOUNT
TESTS MADE BY Burgess &Behr, Po Co Date T�/73 f
DESIGN
Soil Rate Used 7 Min/1 "Drop: S.D. Usable Area Provided5000 +- SF �+ p
No. of Bedrooms 3 Septic Tank Capacity 900 Gals.. 'I'Ype Pre -cast concj®
Absorption Area Provfi By 150 L x24 width c
op(� lit o -b o cec� ov o n °topsoil;
I. owtW �o setf le 66 days Mien a iT e o cod
niggt render 7 min -or better ercolat on ro x 1 cu u re
_Name Roy A. Burgess 6ignature
^. BU
Address Burgess & Behre P. C. SEAL
Gleneida • Ave .
Carmel, N. Y.. 10512
.THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:.
Soil Rate. Approved Sq. Ft /Gal. Checked by FsRVEN °nom G e
FIELD CBECK LIST
Date:
}
•,•. Insp.by:
INITIAL SITE INSPECTION Yes No Comments
Property .lines or corners found . . . . . .
Can estimate house location . ... . . . . .
Will driveway need cut . . . . . . . .
1., , , . , Ntust trees be removed -note these . . . . ,
Is deep hole representative of entire SDS area –
,_ Additional deep holes needed. . . . . . . . . .
Suz"ficient SDS area available considering
driveway cut, house location, separation .
' distances, etc. . . . . .
.. DEEP HOLE a ATA
Depth: 3
Water elevation:
-- "+-a -,
Rock elevation:
Soils description:
Date : . -
FINAL SITE INSPECTION Ins]. by:
House located where shown on approved plan
C SI)S located- where a.pprojTed , ..... .
Width of trench average
:Slope of the line and trench acceptable . .
-Room allowed for expansion trenches . . . . _
Over 50 ft. from swamp,water.course
Natural .soil..not.,str!, Up�d:...or..SDS area
# unnecessarily graded
r 10 FL. maintained from prop.line and
20 ft. from house . . . _
Separation of trench from house, well !-
�' '
etc. follows plan .
�. p
Number of bedrooms checks . . .
'- Stones, brush, stumps, rubble, etc. greater — --
'4 than 15 ft. from nearest trench . .
lF 15 Ft. of peripheral soil horizontally from
Ytrench . . . . . . . .. . . .
Junction boxes properly set
Could surface run off from driveway, roads,
} ground surface, etc. channel near SDS . .
F< area . . . . .
1.,.,,. Does lot'draina e appear O.K. in area of SDS
i-
'` FINAL GRADING OF SITE ACCEPTABLE
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