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02427
Building Type
Has Erosion Control Completeii ?.
certify that ,the, system(s), as listed.serving the abo
attached), and in 'accordance -with. the standards,
Date
Address
Any person occupying 'premisei served by the a6ic
conditions, resulting _froom uc
sh usage. Approval
available and the approval of the private water,si
subject to"kriodification '`cii change when, in the
Date 12, `�a " 7.3
Not- of:Bedrooms Date Permit Issued
ere'con tially shown on the plans of'the completed work (copies of which are
a nt permit, Issued y the utnam County Department of.Health.,
R.A.
92V0
License o
ucli action as may be necessary to secure'the correction of ny"Unsani ary
shall become null and void as soon as a public saihkery�sewee becomes
when a public water supply becomes available.. Such approval; 'are
if Health, such revocation; modification'or, change is necessary.
/� //.
Title i
5726 a
AP
YORKTOWN MEDICAL LABORATORY W.
P.O. Bolt 99
, ._... 321, Kear St_ Fee$
YorkoW nLe i�ht�t � ^Y o15� a
�. . °3203
_
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER URIL rit;4;tAvtu
PASQUALE TEDESCO 2
CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED
CANOPUS HOLLOW RD. PUTNAM VALLEY N.Y. /
,5AMPLING POINT
WELL
BACT8RIA PER ML. (Agar plate count at -350C).
COLIFORM. GROUP (Most probable No, /100m1.)
LESS THAN 2 °2
. HARDNESS, TOTAL -ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm.
FLOURIDE (F) - mg. /1. _
These results "indicate that the water was YES of a satisfactory sanitary quality when the Is was cPe d.
PER : STANLEY LANDER �r
�.
& J
WILLIAM PFISTER A. H. P.ADOVANI, M T. (ASc
i
, - 9-;zz
I�j If ,
6 I
y
• �.5�!% : r " $ �` /fir` . �;.�;� iiT'i ".,: -:lam
Owner Or Purchaser of Building Municipality v ~
k114Lia&j &S,ZLP_
Building Con tructed by --- p
r��
Locatio - Street Block
Z .4) ,7 L 3-3.
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-
pdnt 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 no.t,the
-failure*of --the system to operate was caused by the willful ar negligent
act of the occupant of the building utilizing the system.
Dated this !O day of
V& c..
19 Signature
Title WL_, Et, o
If corporation, g ve name
and 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
WELL COMPLIETIJ.•; RD'7 )R T
3171
I
i
PUTNAM COUNTY DEPARi-(dFNT OF HI -ALTt
Division of Environmental Health Service,.
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to bu completed by well driller and Submitted to County Health Department together With laboratory report of
analysis of water Sa( —mple indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
yw�,,: s.i..�..�...._..r,_.•,` . _.:1 •a :CR�?RT MUST. 3E SU[3ra�fT i E0' W9�PHtf�'3b :D`'A'YS'U`F_`VifE'LL` COMPLETION: .
OVlNER
/
ADDRESS
LOCATION
OF WELL
_(No. 6 Street) j� (Town) may, (Lot Number)
PP.OPOSED
USE OF
WELL
l BUSINESS
Eg-DOMESTIC CD ESTABLISHMENT, ❑ FARM D TEST WELL
PUBLIC AIR OTHER
SUPPLY 114DUSTRIAL El CONDITIONING (Specify) r
DRILLING
EQUIPMENT
LJ ROTARY
COMPRESSED CABLE OTHER
V' AIR PERCUSSION � PERCUSSION � (Specify)
CASIIJG
DETAILS
LENGTH (loott)DIAMETER.(rnches)
�- r
G �'
WEIGHT PER FOOT 1�
I S I 'l q THREADED ❑WELDED
(D,RE S OED j
LJ YES PI NO
(W'�S CA.9"G GR j I. 'D?
U YES l_I NO
' YltaD
i TEST.
HOURS G.P.M.
BAILED 1_J PUMPED � COMPRESSED AIR
YIELD (G.P.M.)
S'
WATER
LEVEL
MEASURE FROM LAND SURFACE -- STAI IC (Specify fee:;
DURING YIELD TEST [feet)
Depth of Completed Well f
in feet below land surface:
SCREEN
MAKE -'
LENGTH OPEN TO AQUIFER (lent!
DETAILS.
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (,'ndhes):
GRAVEL SIZE (inches)
FROM (1001) TO (toot)
DEP1H FROM LAND SURFACE
FEET to FEET
FORMATION DESCRIPTION
Sketch exact location of well with distances, to least
two permanent landmerks.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COM IETED/ DATE OF FIEPOflI' jWULL Q.RILUERrA Si� >> uro
FIELD CIECK LIST
4. .. Date.:
.Tnsp...
INIT.Mt SITE INSPECTION
Yes
No
Coma -neA�
Property lines or corners found * 0 *
Can estimate.house location.. o 0 0 .0 0
Will driveway need cut o
Must trees be -removed-note th6se . . . . . . .
Is deep hole representative of entire SDS area
Additional deep holes -needed.
Sufficient SDS area available considering
.driveway cut,house location,separation . . .
distances., etc . . . . . . .
DEEP F-oup, DATA
Depth:
Water elevation:
Rock elevation:
Soils description:
'Date: 11-26-73
FINAL SITE INSPECTION Insp. by:/ de
House located where shown on approved plan
_V
ST)S Tocated where a-pr.rovec-1
Width, of trench average
Slope of tile line and trench acceptable
Room allowed for expansion trenches
OVer.50 ft. from - swampwatercourse...
Natural s61l-_-n'o`t stripped or SDS area
unnecessarily graded . . . . . o
10 Ft. maintained from prop.line and
�1- 20 ft. from house o
S-paration of trench from house., well
etc. follows plan . . . * * . a
Number of bedrooms checks . . o I o
Stones., brush., stumps., rubble., etc. greater
than 15 ft. from nearest trench
15 Ft. of peripheral soil horizontally from
trench . . . . . o . . . . o o . . . . . . . .
Junction boxes prope-lay set
Could surface run off from driveway, roads,
ground surface, etc. cannel near SDS,
area o o o o in
Does lot drainage appear � 6.i. 0 -
- area of SDS
FINAL GRADING OF SITE ACCEPTA=
xty . is
,7AO Z C�,, uk,
� H, )
U
TNAM COUNTY
"DY'VI'SI'q!7 of Eh erlid
'C6NSTRUCT16N'-." PERMIT. . FOR" SEWAGE 'DigPOSAL��"�.SY
'Suiidivlslo
7rj;-
'Ty Lot,,.,Area,,
.14
.Nijrnber of Eiddroo 7r kc
"ms'.
Separate-Sewerage,Sy st em
to consist of
4:1
co C-"
tv 'Tfol"66 constructed by
Water Supply : Public Supply From
N,
'i6rivii " e'Supply to be ; `d'
y
' Address PL' 'r
Other, 2Requiremerits eo
represent :that + am'wholly,and completel Tgn
:above . described will tie c6;nstructe6aks -
h
r
;County
-Depar�tment of, Flialth,' arid. f e C
Qh
e submitted to the. Department M _gUj
ff'an
aran
f r5 place' in good operating condition' wage is
j
ti m
'
ante of the approval of. the 0 er 0 o irucxion(�
•'.W'11:be located on the appr e Ian it �Vli
Count` epa
6 iirimeiit-6f'�He�lth.
,
Pate j
-Address
44! es, year
APPROVED FOR CONSTRUCTION T
revdcab'le for cause ,or may Obe' amended _oIr.m
iegu'ires a 'neW �p�rhriit.- Approved for disposal 6 Aomeifl�'Ja'iina'
,
VIq rM 'N. "Y'
lloge
I- Ock IK' 11�tA
ctmn ......
'Job*'—
Address LB PoOV_ ISO L+
pace Square Fee
u Total t
-Y
lineal feet X width 'trench
Address T Ul A) -APA Al
y
W,
T"C�91ior 'Of". Iqe
PrC " )pq',sjjst6ffi(i)T i)'-that the sdozirat6'MseWage disposal system
t:there to and � '
Ith the,standards.,,'ruies U.' the Putnam
'wj an re
jqaccor. a"e gulations o
.i4�wl d qorstr�uttioq Cqnp-lii apce, satisfactory 'jo jAkomm
lisionir of Health will
nished the owner .'.'his by h builder, that said builder will
_qirs, or assigns the b er
i�itq� during iheperiod of two years immediately following thedate of the issu-
th or rnal system or an . y-reoairs thereto; 2) that the drilled well described above
e �ir
stalled I c'Orda_h _ h rd s, ruies . and reg of the Putnam
ce w uTaMo
P.E. ' K.A.
'A -Uj cti
40. License No.
:)M-. the 'date issued tii4ss construction� of the building has been undertaken' and is
,
: ii" ,he of
Health Any ..
ny c k ange . *o*'r ' alteration of construction.
swage d/oriprvat e water SUP T I y on I y.
1-5
Title
r - t
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•
a
PUTNAM COUNTY DEPARTMENT OF HEALTH
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner PAC CALL r IGO A, Address *7-2-OpAL
i a,;hAI r
Located at ( Street & : -,w o ' "S Block Lot 5.3
n i°a e nearest cross street)
Municipality 90d OE Watershed (.A -a-El(
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Water a er ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
P 1 1 7. ° fir` 2,:446 1 (` . ?9 a,7 I A 4.. �,
2 1.4( 2: 5'3 4 f_3 3 -�
4
5
2 31
3
4
5
Notes: 1) Teets to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH
-----,-,DESCRIPTION.,OF -SOILS,.ENC
F
DEPTH HOLE. NO.---Rl HOLE NO.
G. L.
611
12't
1811
2411
CATION
, "7�
HOLE NO
3011
3611
42't
4811
5411 14
60"
6611
7211
7811
84 if
/Y
IMI CA TE -LEVEL�. AT. - WHICH. C H. GROUND WATER I S ENCOUNTERED OUNTERED IP �
-----'-'-T1M1CATE'=1T-T0 WHIC W TER'' LEVR-L RISES '-AFTER-'BEING'ENC'OTJNTERED7'--'-
TESTS MADE BY -Alyu , xw-�, Date
DESIGN
Soil Rate Used Min/1"Drop: S.D. Usable'Area Provided
Type. No. of Bedrooms
Septic. Tank Capacity Gals. rype co;�rr�
Absorption Area Provided By_ L.F.x24" 5b" width trench.
STANLEY �. LANDER
Address
THIS SPACE FOR USE BY HEALTH DEPA
t klo Zjt
Soil Rate Approved Sq.
Date
?k%7
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