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41.14 -1 -39
BOX 20
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02360
/?- 141--5 -7/
OWNER'S NAME a rn e UJ 01 PHONE
SITE LOCATION 'Il'4$ 16 �-
MAILING ADDRESS Rik S?�/1'% (4 ��-�' A I V
PERSON INTERVIEWED PaM Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER Za e' e PHONE
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect. ) ^ A f /% A
Proposal approved V—
Proposal Disapproved
Proposal approved with the following conditions:
C-�e_z 11 ��Ze�;7
to .
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep
dryw ells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I. as owner,
or reported agent of owner agree to the above conditions.
SIGNATURE
TITLE c�
DATE
.. : V&te (MD); Yel]Aw (U= H'I); Pink (%PUCEnt)
„ 3
j
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y !Oh ^ io'
TINS is to' certitf' PA the sowa;e
u�sposai. sys; ors coasispau a in
diceted on this n;aa a- G,e; tiie spton
as CI rc @.,fva it was Shied
m The' stste,:. its .rum;';Ocd in
ucotda�ce wt>t sii •Le r'ssw rego-
.:. -gtioas-o�,1Ae— Psiaam'B�e:p lJc;r�` n, :' : a --
9lnoWv�.ti6ra'7n f.izri Owl -iS
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PUTNAM COUNTY DEPARTMENT OF HEALTH
U Division of Environmenia/ Health Services Carmel N.. Y 10512
1J
fR'UCT,ION PERMIT. FO,R ' SEWAGE' DISPOSAL_SYSTEM .`. I
'i'/- MA
Town or Village
- 9_ocatetl t o x��41 .644 aan p Q I ac Bio k
;,.
Subdivision Job
Lot
r Owner �9�MES �%�.:6.7li Address 4;,-
Zr
Bu�Iding,Type L�i`�e if r Fs 4i Lot Area "'��
Number of Bedrooms 40.
Total Habitable Space """� Square Feet -a
S,eparafe,:Sewerage- 'Systemi o consist ofd® Gal Septic Tank lineal feet X w`,idth trench
e To be construetecly by ` 3 >R g aD 6- -ee Address
r,
Water Suppiy...' Public :Supply Fr.'om
Id
Private SuPPIY to be drilled by
,Address l
P . 2
Other Requvements
I representthat I am wholly antl comp) 171e _ and location, of: the proposed •system(s) :1). that` tti6 -separate,sewage'disposal_ system.
...
above'.described will be constructetl:.as'" nt there to and -in accordance with the; standards,yrulerari regu.a for o e; u nam r
County '.Department of Health ran p . t Y rtifiCaie of Construction Compliance" `sat�sfactory.to the. Cominlssioner of Health'w�ll
be`.submittea "to the Department - wri ,` ill: rnished the owner his successors he!rs_or assignsHbyrthe builder,-
that said builder -will
R in 'good. tcondrti on. y F rt', i' , dis osa system duri�g.,the period of two (2) years immediately followmg_thedate of theissu ? 15 ante of 'the approvval of 'the Certife,'of'C ?l, mpl nc ofaheori `�nalsystemorany.repa�rsthereto 2)'that +the`drilled; well °described atova,'`
will be iocated as shown on; the apps d� _n a II w stalled m accordance' v st&hdards rule a d regulations of the Putnam - '}
County D artment of Health s { i
Date I LL`s No 3Z�' ,, y .Ra:/ P.E R A
Address -
_ ®S�
6 / License No ♦ S Z�a'"i
APPROVED FOR CONSTRUCTION This approval. expires one year from the 4ate issued unless construction of the building has been undertaken and is'
. _ �-
revocabie for cause ormay;:be arhended or< modified, when co hsidereil:necessery by'�the Commissioner of Flealth:�- Any change or.�alterationof_construction �
requires a %new e! it Pipproved for disposal,of domestic sanitary sewage, and /or`-privater„ water supply only
Date ���Z BY 1
Tit le°'- -� i
PUTNAi1 COUNTY DE?A?T.,1E 7 OF
DIVISION OF E NTAL HEALTH cz W10ES
DESIGN DATA S'rIEET - SEPARATE SE,-AGE
DIS?OSaL SYSTZ.I FILE NO..
:.
Owner h/4i �� � 1
Address �� 32, � ►�Se/i � ,�'_f�. %�"
tre.et)�Up�,,,f p-
Located at (S C -
�-•_ 0 6 Block, `^
_
Lot
(Indicate nearest
_
cross street)
Mun �; ipality ✓ccrh. +. G 10V41 `
Natershed
SOIL PERCOLATION' TEST DATA. REQUIRED -TO BE SU'1"T7 -1 PD 1, ITH APPLICATION
Hole -
Number CLOCK TIME
PE RC01�4TL0N
PERCOLATION
-.
_ Run Elapse
Dept:: to trate'r Prater Lec,el
No. Time
From Ground Su r =ice in Inches
Soil Rate
Start Stop Min.'
Start Stop Drop in"
,i�finlin :drop. -
Inches Inc=w Inches
J
3 c S B/ v 2 2-
As f-
4
0
7.
ZS
4 -
S
1
2
3
4
S
Notes:
1) Tests to be re.peated at same depth u:,til approx_- =_tely eaual. soil rates are .ob-
tained at each percolation test hole. All data to be subiiitted I'or ret: ie:;
71 T1 a t r... . ..,tc� to I— mmr?n -F"n" +-nn nr In n1 ct
TEST PIT DATA REQUIRED _O EE SL'B,IITTED G,'IT_�{ APPLICATION
DESCRIPTION OF SOILS L`•' O NTERED I_•: TEST ,HOLES
DEPTH HOLE NO. - .HOL_, NO %�? HOLE NO:.�� i? v
12t.
24'r g.
30"
36f. _ a
5 41f
It
0
-•
�1
2 ; . Lvv—
84.:
INDICATE LEVEL. AT WHICH GROUND W TER IE ENC0U`'TERED iii' 46'o-frf'r"
INDICATE 'LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS. KADE .BY 5 1 Date /? - j 2--
Soil Rate Lis edi I1' : /1 Drop S. D. Area Pro" _dedJJ--Y O .
_ 1 T
No . of Bed> oo.-� Septic T Gals . Type %4 -1 r� r � '.r�.
Absorption Area Provided. By gAR2 6" cam�'idtn' trench. -0tner
NaMe CJ t ANLEp, �o L1i � E' I`Y3C,a• uie 1f�
�n�`o, f�
V.
Address -OX f :rid l EAL t
PUT'NALM COUNTY DEPART`9 NT- OF HEALTH
Soil. Pate Approved Sq. Ft. /Gal. Checked by Date
Z
fl
1Z
.:. rjO0 7{%A St A��
:APP Z A tA ATE:,—
'T � t i.2_ TO
GAR RAL, NOTES
_
All requirembnts and, construction
Z.6. a4'
details shall.me6t the requirements
of the Division of Environmental
Sdnitation, Dept. of Healtb.of the
County.df Putnam*
2. -,House sewer sLll be 41'' east iron
1/4 1 foot,
set a grade of _nch per
"'a '-Z
AZZ ,
VO,�GT OF Z. wal�ertijght and, root /
proof.
3 Provide 411 approved non-metallic
pipe or 6qual to junction boxes witt.
Slopes: as required to meet field
: GJZ' conditions..
4. Absb*rp tian fields- ''shall consist
of .4,,. open Joint or perforated
bituminous impregnated fiber pipe
1 1/1611 per foot IT
aid. on a grade of
washed gravel: or crushed stone of
uniform size QAO' to
o 2 1/2117. Tile
shall be laid '_1 n
13" of stone so th=
i-ts invert shall be :6" from the
bottom of the trench.' Cover over
gravel shall be 5" minimum to 15"
maximum. The minimum cover shall b,
used wberever possible.
Disposal tields,shall be 3611 wid,
&nd_ of. the length shown on the plan
6 ?or details of -septic tank,
7
distribution box and junction box,
See County 'Standards.
7. All trees In field area and
J'- within ilb' thereof shall be removed
During any construction, keep
heavy loads off field area.
9. Leader and footing drains must
discharge away from septic_!_�iel.ds_
J 10- Well -log and water analysis S
,
must be submitted to Health Dep,21
14; j. T) before Certificate of Construct
Nt
Compliance will be issued.
P
UTNA*
D
0-7. "S
LC
T41) V-4.
4 900 GA&. SEP. 1C, T�,k"4
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OP , 5 Q F
A
5L
F-
-t" T->E-
X' TOP'- _eDer
I L
Roe C
5 AL'F_
VEP-T,
10 %
5--PTi C SSY'ST EM L
s. n.-... s. �. Mn,:. am�acmu�.+: ec+ rR..<. �:• .ru.- a.v�....r�x.+sr;�.- �.as• -a �.o -f _avr. .�a.ar�+.c.so. .• •..•_• _••�. --• ....,.nvc.. u.vi.r�a:.rru�._.... r- ..a�.�..
PUTNAM COUNTY DEPARTMENT OF HEALTH
Gentlemen:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date % Z---
Re : Property of �/�/'9� %- /f'•�,ZG'�i� C' i f7 :L -r/je
Located at %�t/i��Ji�YG"' S7-R el---71 4Y9/V
Block Lot
This letter is to authorize f. STANLEY Jo LAN DER
a duly licensed professional engineer or registered architect
(IndicaTey-
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the:.- Gommissioner of the Putnam County
Lepartri -,ent of Heaiti, and to s:igri all Ilecebsary 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
Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
C
P.E., R<A:, # 15212')
�n�
STANLEY L DE _(Seal)
6 re , . V 6)07
Very t y yours,
,r
Signed
Owner o Property
�yz - 06"' z 3 Z - '-Xe,-
Address ,/'
,90SL.
Telephone
_ _
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
? 85 JOHN STREET, NEW YORK, NEW YORK 10038
Dace + Augus t 29, 1972 Application No, on file 586095 N
_ „14, .
IERTIFIES THAT o„ ;_� ..� -`•� w. ,,.,.,., ..�...:
!,'THIS,+ .. �%;, 1
o! ly sthe electMrca! equi�megtt,a t describslrrn iLhc� "introduced by the applicant named on the above application number in the premises of
,;li „r {zJstdes{ Wals�i, Pudding St.e/ Roaring Brook, Putnam Va11eq, N.Y.
.
outside.
-'tn'tiic foflowtng 16i: ti B gem nt 1st FL O 2nd Fl. Section Block Lot
Au uo t 24 S7�
{wads examrned g !.
l on and found to be in compliance with the requirements of this Board.
'ij FIXTURE „`
7 OUTLETS S +
}' `+ `
ECEPTACLES
SWITCHES
FIXTURES
RANGES
COOKING DECKS
OVENS DISH
WASHERS
EXHAUST FANS
FLUORESCENT
vNUR
AMT.
K. W.
AMT.
K. W:
AMT.
K.W.
AMT.
K. W.
AMT.
H. P.
INCANDESCENT
?` 23+.7
i41:•.
30
23
1
5.
1
1.
2
F
r.. , .., .. ..._,.
FURNACE MOTORS FUTURE
s .
APPLIANCE FEEDERS
SPECIAL RECTT
TIME CLOCKS
BELL UNIT
TRANS.
HEATERS
MULTI. OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
H, P.
.GAS
H. P.
AMT.
NO.
A. W. G.
AMT.
AMP.
AMT.
AMPS.
AMi.
H. P.
AMT.
WATTS
it
t
{
I
1
30
SERVICE rDISCONNEGT Y
NO.OF
5 .. E R V 1 C E
7 AMP ;, { ,TYPE,'.
METER
EQUIP,
t,0' 2W
1 A' 3W
3,0' 3W
3,B' 4W
NO.OF CC. COND.
PER :0•
A. W. G.
OF CC. COND.
NO. OF HIAEG
A. W. G.
OF HIAEG
NO. NEUTRALS
A. W. G.
Of NEUTRAL
.li r
200
CB
1
4/0
2/0
x
1
dTHER APPARAT'I 1 ,
t,
gil
a. heateie
`�lfF 1ec: t'roiim' eaters : ' 2 -2; , 1 -1, 5kw. 6= 1 :25kiv. =1.kw. 2 -. Skw.
!;
.:' +t 1 + j { , i'i ,
{�• ',' +• 1 , {''11;
{ii
711
{�! i �i
�'Sflli ��j 4m {i��l�� {�l 7 ,•
73].
' ` 7 foram Turned E1ec.Inc.
7. Bvx, 0
Brewster,' N.Y, ].0509 Jw''a
, ,
GEMfdFAi 1ANAGER '
{I• ?, _S n, - -
06
Per'
fahjlsLceitlfiiate,.musf not be altered many manner;, return }o. the office of the. Board if incorrect. Inspe, tors Toy be identified by Air cre entia{s.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM VAw_r,' y
Town or Village
Located at ti Q 4 ' ��r r �seetief Block
Owner AM 5 AL l+ Lot Q1� ,. r// Job
Separate Sewerage System built by A S s K A �40 c Address _ 12 AI AM L 4"C
Consisting of Gal. Septic Tank 1 6 4 lineal Feet X ��� s� width trench
mra[er
8ulldl
Has E
Other requirements
1 certify that the system(s) as listed servin r w ei ted essentia ly'as shown on the pl 5 of the completed work (copies of which are
attached), and in accordance with the s , do s filed, a 'the permit sued y the Putnam County Department of Health.
Date L' �. }' tiff,'
,... Qom& ,� , y%
• 111+• qty �
P. E. R.A.
r.. �GLfI ._.....
Add s d - _.I _. _.. _- ..._.. License-No: .._
Any person occupying premises served by th ptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Appro a we►age system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water sup me null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the Judgment of the Commissioner of Health, such revocation, modification or change Is necessary.
Date By Title
h
op
2'/ Off'
O�
Ai
MAP
Vol
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SiTtvArf- /n/ � '
Pgrsl cra/ Wher4r. A4ow it::
Ng
Af-
Ref AMP
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.. ... �•._. a. ._ ..ter._ . ... - - -��.i � , .. .. ... { -•' - \- _
DAVID D. BRUEN
County Executive
_ DEPA
James & Margaret Walsh
116 Pudding St.
Putnam Valley, New York 10579
RE:
Dear Mr. & Mrs. Walsh:.'
J _
JOHN SIMMONS, M.D.
Deputy Commissioner
nmental': Health Services
Recently an inspection of the. sewage disposal system and well serving the above
captioned residence was conducted by a representative of this Department.
Subsequent review of Departmental -files indicates that a Certificate of
Construction Compliance has not been issued for the completed sewage system,
therefore, final approval of the construction of these facilities was not
granted. While we realize the difficulty involved in locating older records, at
this time it is requested that.you attempt to locate the following materials and
forward copies to this Department to complete our files:
1. Well log fran well driller.
2. Bacteriological analysis of water supply.
3. As -built plan prepared by the designing engineer or architect.
Procurement of these necessary documents may be facilitated by contacting the
well'.driller, engineer, former owner and/or Town.
You should be aware that proof of approval of the sewage and water supply-...
_ facilities serving this property may be required relative to future sale or
refinancing of the property. Therefore, it is in your best interests to obtain
the above- captioned documents.
If there are any questions 'or this Department cane be of any assistance in -this
matter, you can call the writer or Mr. Hodgens at 225- 3838/3833.
�}ery trul 'yours,
t:
hn Karell, Jr., P.E.
Director
Environmental Health Services
JK:mk
cc: E/A F/1 /jk /jay -4
S. Lander, P.E.
M. O'Dell, PV Building Inspector
File
TlAln rni IPITV ('ENTER - rARAAFI . N V 1f1IZZ11 (01A) 77[_�LA1