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BOX 21
02425
t..
CERTIFICAT -E -OF
Other requirements
Water Supply:. Public Supply From
Private Supply Drilled By E/JjI/, S'Q V,
Address
Building TYPe Ct(�LET' Nos, of' Bedrooms
Has Erosion. Control Been Completed?
I- certify that the systems) asa fisted serving .the above premises were constructed essentially as shownori the -p
attached), and in accordance. with': the standards, rules and regulations plans Bled; and the - permit issued . l
Date • + Certified b'y'
Addresses /A?
y Y , (ai , p w.. on as maybe nei
An person occupying premises served b the above systems 'shall romptly take such actt
conditions resulting from such..usagei Approval of I he, separatesewerage, system "shall become null and v
_ ...
available and. the approval of the private water supply shall become null,and void :whan',a' public water.
subject to modification or change` when, in the' of the `Co isioner'of Health, such rev tii
Date By _
lu
.Date 'Permit' Issued,�!�!�'�3 /�Li�l_
ans of'ttie completed work (copies of which are
he Putnam County Department of Health:
P.E. R.A.
License No...
rr—`—
BSsary'to secure the correction of •any .unsanitary ,
id as soon as a public .sanitary sewer becomes
becomes available. Such approvals are'.
n, edification, or. change Is necessary.
Title's
.MEL and HARRIET GOTTESFELD _
���,1ri�.er or Puroric.;;cr oi' Bul_�_ci1nE; ,__.
_ KEEMAR- BUILDING CORP.
Bu-ild�i.n.g GOnstrucLcd, by
I� Dennytown Road y
Location - Street
TT Putr A V_al
1 !un i s 11) a-1 q t y . �... �.
7c—tIon
Block
..Chalet.�d
)s, Tyl) e Lot
GUARP.ITTY OF SEPAR.n.TF SE11AG E SYST1 11
I represent that I am wholly and comps etely responsible-for the
location, wor? -mianship, material, construction and drainave of the sewage
;. disposal. system serving tb.e above described property, and. that i.t has been
constructed as shoirn on the approved plan or ar_proved amendment thereto,
and in accordance frith t1ie standards, rules and regulations of the; Putnam
County Department of :iealth,. and hereby guaranty to the cvrner, l'is succes-
sors, 1-).eirs or assigns, to place in good operating condition any part of
said system consf;r.ucted b r inie which fails to operate for a period of two
years iri- ediately fol3.o1;:.*1.n2 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 is caused by the H-illf.ul or negligent act of the o--cu--
pant of the building utilizing the system.
`.Cdie undersigned further agrees to accept as conclusive the de-
termination of the Di rector of the Division: of Environmental Health Ser-
vices of the Patnain County Departirent of Health as to whether or not the
- .failure of the system to operate was caused by the willful or negligent
act of the occur) nt of the building utilizin` the system..:
Dated this day of 4-, C 191 Signature �M .
,
'Ti. t''
corporation, give name
and a.ddr. e s s )
1 COPIES 1 T �� T T �"'1 T
THRFI, (3) COPIES ARE REQ IREID WITH THF�EE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COM P�_.ETION VTILL BE ISSUED.
GUARANTOR TS R`,r -TIT= TO FILE NOTICE OF DATE OF FT %ST USF OF SYSTEM?.
Division of Environvianta1 Health Services, Putnam County Department of Health
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 35 60
SOURCE: Mel Gottesfeld - faucet - well supply
.Dennytown Road
Putnam Valley, New York
COLLECTED: Dec. 5, 1975
BY: Phi I ip Lo Capra:
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
N
0 per 100 ml.
This result
indicates the
source of
the sample was
of satisfactory sanitary
quality when
the sample
zuas collected.
Dec, 6, 1975
I
Roy Bickwit P. E.
Director
WELL COMPL'ETIOW REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING . CARMEL, NEW YORK
_. This,report -is to be completed by well -driller and SLIbn-i.tted to County Health.;Del -m tment, together _with_laborDto_ry_repor.tof;
"" ` "anaf'y'sls'ort`:vva�er sarnple =iridice'tin'g GvaTeTTs'6f'satisfactory bactaiar'quality before certi #icate OT construction comp Mance Is Issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
ADDRESS
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Dennytown. Road, Putnam Valley, New York.
PROPOSED
USE OF
WELL
BUSINESS
L DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER )
DRILLING
EAUIPMENT
COMPRESSED CABLE
W ROTARY ❑ AIR PERCUSSION E] P PERCUSSION El (Specify)
)
CASING
DETAILS
LENGTH (feet)
I DIAMETER (inches)
WEIGHT.PER FOOT
C THREADED ❑ WELDED
DRIVE SHOE
❑ YES @ NO
WAS CASING
❑ YES
GROUTED?
L_1 NO
YIELD
TEST
�j
❑BAILED ❑ PUMPED 11
HOURS G.P.M.
COMPRESSED AIR
YIELD (G.P.M.)
10
WATER
LEVEL
MEASURE.FROM LAND SURFACE —STATIC (Specify feet)
20 Feet
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below Land surface: 255
SCREEN
MAKE '
'
_
LENGTH OPEN TO AQUIFER (feet)
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 SURFACEI
FORMATION DESCRIPTION
Black & White Granite
Sketch exact location of well with distances, to at least
two permanent landmarks.
Fcci iv :�ci
0 255
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
____9/7
DATE OF REPORT
112/7/75
WELL DRILLER (Signature)
J`
DA TA
/.SOD
To
---- ------
7 71
c 7-A,,v I<
it A 4
.0
la'G1 19
OF HEALT)b
IVISION OF
�R, D. n
........... ...... .. .. .......
Dill
'*,"'MqlwFNTAL HEALTH
Q x
�f Enliironmeni
Bwlding Type= L Lot Area
Number of Bedrooms
Separate Sewerage System to consist Hof -h "
To.:be- constructed by-, ^�
Water, 5upply: L Public Supply: -Fro
Private Supply. to'
r .
Address
Other "Regwrements
),represent that :I am wholly and'completely.r
above described Will - constructed'as'shown
Counfy - :Department of eii ealth, and -that on,
be sutimifted. to the., Department and ;a wr
place. in .1. ood operating ciindition, any.-;part
ante of toe �approv61 of the' `,Certificate of
will be:located;as shown Ion the ;approved _plan;
CouMy;6'
IP
artment '& Health
Date k. +�D 1 /
fi z.
Address
APPROVED FOR CONSTRUCTION. This ai
�....,
revocable' for cause or may be, ariiend "ed or mi
requires `a, ew permit. ' Approved for disp�
m
DEPARTMENT
t
fealt!h Services qar /j N. Y.. -10512 a
EM
Town or illage I
�t
Secti on
Lot JobT_ll—
.Address' �L�Sr�1 �r+:►S ,��„
Total Habitable Space" I Square Feet
dt t h
irilled'.,by� 1'
r
niee Will De,
swage dispis
in, Compliant
id'well will tit
Tr
Signed
Ares one :yeal
m- considered
nest ic sanit"
ation of t'-h' e'
e to and m a
to or Constr't
d the owner;=
m- during -the'
ie original sys
,d in ;accorda
ie date issue?
y _by - bbh ,Cb
e dor pn
lineal feet X wt h ; renc
dress � �
oposed system('e) 1) that the separate sewage ,disposal system
irdance with the stand r
ards ules an d -regulations o_. the.vutnam
ion Compliance" satisfad- to the.Commissioner of Health will
ssucce3sors,.tiei_rsor a`ssigns;by_ the builder, -that said builder will..`
riod,of; two (2)9 years immediately . following thedate'of the issu-
n or any repairs` hereto, 2) thet.the drilled ,,well described -above
w
a ith the sta aids rules and: regulations of the Putnam .j
RA
t
✓��'�` �� License Not ��� �`�
anless constructton�:of -, building has been undertaken'and is `•
nissioner of_Health Any change or alteration of construction
e* ater supply only •
2
• 'Title
VUTNAM COUNTY DFPARTPT,dT of BRA.L`i'H
t
DIVISION OF ENVIRONPENTAL I-D ALTH SERVICES
C*OUNTY..OFFICE" 10512 F
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
n =a..
Owner �.C_.y�1� b:M =5Address PMU;LAe-_s if--I .
Located at (Street �. Sec. ? Block 1 Lot
dic' atb nearest cross s reef
Municipal it;
_ 'Watershed S��1 lr�,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIOP S:
0,V
3
l =i � P'•P' LS£ � N' i
s ra ~s
3
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 submitted
for review.
2) Depth measurements to be made from top of hole.
R-0 re—
Number
CLOCK TIME
PERCOLATION
PERCOIAT1'ON
Run
Eiapse
Depth to a
er
Water Leye7u �� �, ..::.mot
No.
Time
From Ground
Surface
in Inches Soil Rate
Start -Stop Min.
Start
Stop
Drop in Min./in drop
Inches
Inches
Inches
1
►� .-� S
u P.4
,
10
lqjkl2
r
w4,
`6
10
1 16I 1
- 5
0,V
3
l =i � P'•P' LS£ � N' i
s ra ~s
3
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 submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQ1JIM..D TO PT; 1-1.1111 APPL-1-CXVION
D,T,,,'3CRIPTT0 11,1 '.i_.E5T HOLS-Z
tt
DEPTH 11OLE, NO. HOLE, NO. HOLE NO.
611
181t
2411
3011
3611
42't
481f,
5)[11
6011
6611 -
t-, s
PA
7211
7811
4' I' I
84
INDICAA,�JXVEL AT
1-if HICH GROUD1D WATER
TS ENG,01LINTERED
0 1
&,R
INDICATE LE`VETL�.�-O
WRICH WATER JLEd,1
RISES AFTER BEING
EWCO'01T
D
TESTS IWEj BY 1--'>
T-1-A <-!:F \1 QM
\j 1--,F
)Pate
I(*
DESIGN "
Soil Rate Used
MiiVl"Drop:
S.D. Usable Area
Provided—
No. of Bedrooms ",75 Septic Tank capacity 900 Gals.
Absorption Area Provided- x24" ------- j-6" --w.ic
F-a-P P, ej m_ Ic" D I At, - qrt�q
Name -%GvN p%a_0 Signature
Address
ZZ
SEAL
MZLA�
trench.
er
i , "Nyssu" -_Mw
THIS SPACE FOR USE BY HEAII.PH DEPARTP/E.K ONLY:
Soil Rate Approved Sq. Ft/Cal. Checked by to
'.u.. i'. _. �/• ��.. ..+� •a.n..•.r we a.... .� ... ..ta._... u..�...�. ..... .... ...A...... ..... .. ti -. � .., ... �..._.. e.i� ..s.
Ou-
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
y -
Date
Re:.' Property of L,v E %/� ��' d 1-1 —Asf �cl�
Located at .dl17 /y /C'v • i��, rv�� l%ccmay' /� y
A
TM d3 Section 0 7 Block G Lot 3
Gentlemen:.
This letter is to authorize �,,zn� y �It,y ,
a'duly licensed professional enginee'r,to apply for a Construction
r Permit -for a separate sewerage system; 'to serve the above noted
4
Ni•''
property in accordance with the standards, rules or regulations
>: as promulgated by the Commissioner of the Putnam County Department
of Health ,.and to sig n all necessary papers on m y
behalf in con-
nection
with this matter and to supervise the.construction of said
system or systems in conformity with the provisions of Article 145.
or 147, Education Law, the Public Health Law, and the Putnam County
Sanitary Code
,. Carmel New York 10512
914 -225 -8088
�' SEAL
Very-truly yours •,',
W
Signed
Owner of Property
Countersigned;
A, ro�:
A dress
P.E.
# 38998
t t �,,'
�,�� K, sriG� Y
t ,
Howard A. Kelly, Jr
Telephone
34 Gleneida Avenue
• w� _
,. Carmel New York 10512
914 -225 -8088
�' SEAL
e
Prop::rty. *U.ncs or corners found . e
Cw..i esti.;ratc; hou:,e location,
i1:I.1:1. dx�ive�.�ay need cut . e e o e 0 0
P:u:yt trees be rwovod -note these o. o e e e
Is deep hole representative of. entire SDS area
Adc):i.I,:ional dccn lioles needed.
Sufi,':i.ciwit SDS area available considerii)
driveway • cut, hsouse location,, separation ,
distances, etc. o e o ' o o e 0 0 0 o 0 0 0 0
Dr,, E? IME I1 1 A
Dopth : '.
Hater elevation: �-
RoCk elevation:
Soils descrirtion:
Date':--
0
FIVA:L, SI'Z'E ITISPECTIOD1 Insp. by
House located ivher° shown on approved plan . e
ST)S) locate d''i'rherre a,pprovnd
— .. ✓....�4_- :ice vim. .: :: �•1� ...:.: C: �. �:i��% .. ..... ..
Slope of til•e 1i r_e and' tr. enc.l acceptable o
Room allowed for expansion trenches 0 e e e
Over 50 "t. f. rom s i•;at�n) i-ratercourse .. e 0 0 1.
Natural soil not stripped or SDS area -
unnecessa.rily graded
10 Ft..., m inta x.ed from prop.line and
20 ft. from douse . . e e . . , . e e e 0 e 0
Separation of trench from house, well
etc.' follows plan ... e e e,, 0 0 0 0
Nwrnbor of bedroc-.:Is checks . . . 0 0 0 0 o 0 a_
Stcnes, brush, stumps, rubble, etc. greater -
than 15 ft. from nearest trench . . . e o e
15 lit e of peripheral soil horizontally from - -"
trench 0 0 . .' 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Junction boxes. properly set
Could surface run off from driveway, roads, e
ground surfE.ce, etc. channel' r_ea r SDS ,. e
area. . e 0 .. 0 0 0.. 0 0 .0 0 0 0 0 '0 0 0 O 0 O _
NOSs 16t dr. aina.Ce anrear 0. Ye in area of: SDS
P111 AL GRADING OF SITE ACCEPTABLE
e
e
e
Q
Rh711EW UfLEC K
DOCUMENTS
House plans 0. K.
Design data sheet I
Peres presoaked? i
Min. 30" pert test depth
Const. results for 3 runs i
D. Hole log O.K. i
Corporate Affidavit for other than individual
Authorization. for engineer i
letter from Water Supply if applicable
If variance requested -such noted on plans & apps.:
s Std .1 Remarks
No
i .
i
i
DETAILS'
if change is proposed.,)
Existing contours shown show new contours)
Slopes for driveway cuts, etc. shown
Water service line location 1
Footing drain, etc. location I
Top slope, bottom slope of fill
Percolation tests and deep test pit location i
Septic tank size and conformance to std.
3 B.R. house minimum i
House setback shown
A-LI Wa GE. 11 Wi. ul-all )V l u n U1- -r.0 atluWii i - .......'.
Plan and profile SDS
All other wells and SDS.closer 200'
shown or reference made
Property boundaries (metes - and bounds- clearly- shown -_ i
SEPARATION? DISTANCES—SPECIFIED ON PIAN'
10'
to
P. L.
'
201
to
Foundation walls
I
L00'
to
Nearest well
!
I
50'
to
stream, march, lake, etc. incl.expansion.; i
15'
to
Curtain drain i
I
10'
to
water line (pits -20' ) i I
15'
to
storm drain i
10'
to
large trees I
i
01.
from foundation to septic tank I i
5'
to
pipe from.leader drain & footing drain —
REVTaT CIffCK S ET
DOCUMENTS uu.
House plans O.K.
Teets Std. T Remarks
es No
Design data sheet i
to
P. L.
20'
to
Peres presoaked?
.00'
to
Min.F 30" perc test depth
1'.'
Con.st . results for 3 runs I
50'
I
stream, march, lake, etc.
15'
D. Hole log O.K.
Curtain drain
10'
to
water line (pits -209
Corporate Affidavit for other than individual, I
to
i.
10'
Authorization for engineer i
large trees
I
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps.:
i
DETAILS
- if charge is proposed,)
Existing contours shown show new contours)
l
Slopes for driveway .cuts, etc. shown
Water service line location
Footing drain, etc. location I
✓
Top slope, bottom slope of fill
Am T-14
Percolation tests and deep test pit locat-ion
Septic tank size and conformance to std.
3 *B.. R. house minimum i
✓ I
House setback shown. I
✓
-i.l7 W
A-L.L. Wa ell, W1 Un 11 :)U 1. U. U1. r.Lj 6 WWII i -
Plan and profile SDS
All other wells and SDS closer 200'
shown. or'--reference made
Property boundaries (metes and bounds - clearly shown h i
SEPARATION DISZANCES SPECIFIED ON PLAY
10'
to
P. L.
20'
to
Foundation walls
.00'
to
Nearest well
50'
to
stream, march, lake, etc.
15'
to
Curtain drain
10'
to
water line (pits -209
15'
to
storm drain
10'
to
large trees
10' from foundation to septic to
5' to pipe from leader drain &
.expansion
,21L7e MANHOLE COVER I
PLAN
12
�i ,1 Z�Z 57oKEn}i_ y JUNCTION BOX 7
Pt O� V °•c�xy.,y Co. «. - MIN12 =18_ -_
a 0 54.4 (- I - , -
„y, IZ", '�� -'�'� •sue _ _ .� �'y Z °jT".4 4 ;MiN •I •.4 MIN
`0� V -"- d•. gx8xty _ n� Z= t LIQUID LEVEL r
,
j
pA J _ ....._._ P /t. � ''�°°, � ` L,e.•o Wt 'h / ?).`y - � _ F-
CAST IRON
112 SANI T:tiY TE E r -,
SECTION
^,
�� az / TYPICAL CONC. � "� -.' PHe -cast cuNr .i-
lEL.'DNISION t1r' D (((
z SEPTIC TANK i.
GOAP3E GQa`Ja „ �,. HEItaF B'�O,L b'W
ayf ' � . aar..nc1 I
Zoe PI,A�Ivo _ ° 5 e-C 0-r- ° " r_
`N, GRD. LEVEL
EARTH
bA61CFiLL aY JOIN,T
co -sts-T G-f `j.EL¢PAa,G PI'T5 •-. c� COVER
I P.'• - 50' BLDG. PAPER
PRni05E0 �6 CCN iC$o lA- rflOClQliaR 6Gq (r7?t V)SG:�i• e: OR HAY 2
L_2 0T A$9oRP?lorr, �.�+ i PFAFORAlED
2• Di'j�a.r0u-1'lo t•I. �aX 00'[IP+q �' TQ08-�' I a e PIPE C"
2� b �ooTw ILAr . lil =« . 24'MIN Y° 36° i • CLEAN GRAVEL OR
S` -- - 3.50 0 P,aa Ins- y�_I�q- rlort- iiausP_'�C SGPjIL CRUSHED STONE
Qes '1 Artc,'To O,s-{0.,guTtou Sox -ro Z_ Ii SeePAG%S. �T. ABSORPTION TRENCH
4. ..? S5 .7 `1'4 1_LA•nc_f_
15.• 'N\VIV I M' M. NOTES i
SavT,:� I S SYSTEM TO BE CONS "fRU ED I CCORUANCE WITHJH_ RULES AND
I a��\ I 5, Q`�� ,( Pa. -T.e_e.t6 WIT.ttiN ip�t. o REGULATIONS OF THr F�4.4Y�AM COUNTY DEPARTMENT
I \T A OF HEALTH.
Z o�} D, a,2u to I �J15POgAL (Z�A�O �a� 1:e..nr.ov.I;.o,..
6 V/%i�LLS t�Nlt<l jpo oS.S,s,[a. SYSTEM SNALLNOT O BA HEALTH UNTIL INSPECTED BYDO:D.
' I I ENGINEER AND TFIf LOCAL HE Ai -TH DEPARTMENT ,IF REQUtRFD.
SYSTEM TO CONSIST OF A 0J GALLON SEPTIC TLNK
HAM �i I AND FT. QF FT_ TRENCH WITH A, MAXIMUM.
PITCH OF i /IG PER FOOT. PXg�.%tA
5 PITS - � Ac b1 '$ os e
Dt 0.13UjI4N CIISP05AL SYSTEM GRACES kEFERENCEp -In FINISHE? hIR,
FLOOR EL E VATION , UNLESS O-THERW!SF NOTED.
-v t�1,
;4 9oa •_ ��� �h;" S.S.D. SYSTEM- FOR.
zl� ate$ �q?v14 S�'�P�Ut °: R£VISIUNS HOWARD A. K`ELLY,,iR.
Ncc c A. yt ASSOCIATES
l / � ,Al ® �'��� ..0 !. � <} NO. DOTE BY CARMEL NEW YORK t
Q��� (.��:5 � )� f ` c�l�� z TAX MAP NO. r:� BLK.NO. ( `LOT NU.
(/j'�J [ {�� [Q�� /�( 4 , j11� /�a ( TOWN pO�F�)PuTNAM VALLEY
V-•e. _DT PL , / N u `� �;. '� 98 / i/ J _._ _._
Drawn YJYY• . SCOIe Mofen of _^
As go &
• t GAS ��a +/ 4 ChM C Dato Drawlnq qv.
CIO 4 -1()7?-
I �