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02441
>a :; �> � ,.: —. -. PUTNAM COUNTYn DEPARTMENT, OF HEALTH '
4Y t Division of Environmental Hea /th , 1, 2,
,e
` Located at
it SNiy 'R� a
°�tfCd�Vion Qf�'�' .4
Owner,
f3uildin9 - TYPe1f��Q%/ �AL�/{�� Lot Area
� Number of Bedrooms - ' t
Separate Sewerage• System_ . tto% consist of
�..TO.•be ,constiuctetl?by
Water Supply Public Supply .From
-rrvate Supply, to be drilled by: --
n Address 1 y3
Other Requirements ■
' I represent that. I am wholly anJd 'completely "r n
°above.described will be constiucted.as sF' ved a
County Department of Health, and that t1
be submitted to the Department -'and a.. g n
place �n °good operating conddion: any2f sa 8
ance ot'•the approval'of„ tie :Certificate' C nstr
`fir
will be located as :shown on the.approved pi n ' d the *q-.
County Department of Health ?Ia I
Date °� fP�C N ""
�• 'Address
APPROVED FOR:,CONST`RUCTION This a,pp'rovafe
?, revocable for.,, use or;may<be amended "or modified when cons
requires;ja ge permit Approved for disposal p, domestic
Date By -
M
r �fiDC:f ( yo 1
h.• Block
g�
Lot Job
Address ' �LJj.'C� S'T '. P/r<7'6����
s ` Total'Habitable Space Square' Feet I
Gal Septic Tnk lineal feet'X width trench;
... F -
.4441
Sfg Ioca,tUOn of;`the ",proposed -system(s); i) that the separate sewage' disposal system
ere to and to accordance with the sfandards, rules an regulations o • e Putnam
;. to of !Construction Compliance satisfactory to the•Commissioner•of'Healthwill
pe; f d the owner his'succe'ssors heirs o "rt assigns by the'tiuilder, that said builder will
..�., _-
sal; during`xhe period of. two (2)"years immediately following the date of the issu- i
ce 'f.: a origin _system or'any repairs"t.heIr ; 2) `triat the drilled well .described above
e i a d to a rdance;u "it.-., th stenda rules and regula i— o� ns. of the Putnam •. '
P.E. R.A.
License 14 O.'2
feaC the date issued ,unless constructs of the - building has been undertaken and is
e ssary by t Any change or alteration of construction
sewage, a n ter `s y onl
tYS ]•f �i •. ..
Title
.�. -.fit•, ....'�F t C......s�..�� ' _', _+.�'... ,_aii�._..w.....� 1..a.C.. -w. —• .•— '-- -.- _..— .t...x.a.0
PUTNAM..COUNTY DEPARTNM- .T'-:OF .:HEALTH
- DIVISION OF ENVIRONM TTAL' HEALTH SERVICES
Date
Re.:.. Property of ,�; r ha �� �. ��1 °✓� � �
Located at r Ii e c � iA � NOL- U a lly N.
Block Lot,
Gentlemen: /.
This letter is to authorize
a duly licensed: professional engineer L.,,,//or registered architect
..(Indicate)
to apply for a Construction Permit for a separate sewerage system ;. to
serve the above noted .property Jr_: accordanc.e with the standards, rules
or regulations as promulgated 'by the Commissioner of the Putnan County
Department of Health, and.to. sign all necessary papers on my behalf in
c -onnect10- n --i,:, his-- mattar.:and o' -sup '-� to. su er-vi is the_conr_uc:t:i:an _ of..s'aid - -
system or systems in conformity.with the provisior_s.of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
• Signed
Owner of P per
Countersigned* Address.
ephone
17 ( Seal)
Address m
r
c, o
Telephone
^A
TEST PIT DATA REQUIRED , TO.' BE SUBMITTED WITH APPLICATION
- -
.ue. .�.. x.r.i. a...v.��.. s.s..n.v.
_ DESCRIPTION_ OF- .SOILS ENCOUNTERED -IN _TEST._HOLE.S,. ......_.____...
�..i.....x. .... •.... n.. ._. .. _ n.... 3 :4.:s oea.np "fit.. • �. .w ...a .. .c w�� ..
DEPTH
HOLE N0. �� : °' ..'
>HOLE NO.. !�
HOLE N0. D-ef Lf
G. L.
611
12'r ...
SAdP R
18
241?
3.011
36rr
42rt
4817
5 4"
6 Orr
66rr
7211
7811
8471
h
N
7
At
r
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 0
INDICATE LEVEL TO WHICH. WAT R. L_ E L RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date-
DESIGN
Q/
Soil Rate Used.. ��.... ,., Min/1 p
rt Drop S.. Usable.: Area Provided .Jx-ry
No. of Bedrooms Septic Tank Capacity Gals. Type/�'�e Z/ 6.wc•
Absorption Area Provided By ,S2-9!;, o� L. F.x241r 361r t�/width- trench /Other
Name STANLEY I LA
Address BOX 267
� s� a. n � n a A s [A 1 •/
PUTNAM COUNTY DEPARTMENT OF
Soil Rate Approved .Sq. Ft. /Ga ecked.by Date
04-
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION,OF ENVIRONMENTAL HEALTH�'SERVICES.
DESIGN./�ATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owne;V X,1cam ,4�2,6 6 LkVe%, /I Address -3 4uTC. h! �l •VTR �S�a- Y-
T4X/"W-
Located at (Street) 111,5 . Z !' kS,4cff Block Lot _
(Indicate nearest cross street) r-,4wo�'Uj. Municipality 11 yTiv.Qs d4Lt� Watershed 16z&
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water
Water Level
No.
Timer -.
From Ground Surface
in Inches
Soil Rate
Start Stop
Min.
Start Stop
Drop in
Min/in.drop
Inches Inches
Inches
1
2
f 3,� jo: of
17,01
.4
5
2 g-'31
5
1
_ .2
3
4
5
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 madei�from'top of hole.
M �\�� f ��{I�Vnaa�
I In ,
TI,
-M IMAM IN!19409"
Dane :Approved q11bd jmrL9IVj3
777
IF
OFCONImv4m.III'I.,�
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abovfr rdiiieribod will'" 'C"OnStr-octoo as-~n, on 04460—
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m*iad, io,t" Q
iegaft t and
quoramteeq wiu b4
of 4 'disk
AA&
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wail UkA,ted4sishawr-of . I the
so thav' said ,wall will t» Mstallae; area
Ir
ofonami�t
Oats he do t
rivoCapN for FOP.�COtA,STRUC-TIO#4:Th!�000".Ml.!t3tp two cause y"
"se 'oi J 6odlf wd*6A -- Co
911 now 'permiti,' -49ow'Cood for -:dlsbM I of domastk sonhtary awaM. snd/of�
►.7v
'tits
'o,
to the-l�oonfnimi� Of Healthwill
btla'a C~4 satifficiory
ki . s heirs or assigns by the builder, that said bulklervill
110wins thislato of the IMW
.,f :drilled well desalbod aboie.."
Ou
IM, Want
PA.'
License W- Z zo a
unNfs rI r "W.Of- the building has been undertake
and.is
_
aN water ripply on
L
'Title
COUNTY OF WE$TCHESTER Y
NYS FLAP #10108: gEPARTM ENT. OF LABORATORIESAND RESEARCH E11 Rev
w • ' "`, `, ., - LA, NEW YORK 10545
BACTERIAL'' EXAMINATION ,OFDRINKING:ANIEATEDiWATERS, /
Lab.No. W z Bottle No.. of `�
nt T
4b Rl s do2
Time Set �
Time Submitted
Tes'ts(circle) SR Col)form P /A, Conform MP ,Fecal, Other'
't
Coll tl By Agency Coll' d For -y
CoIPd From (Name)
)' ' ' e; o ..:` `First � .. P# � ✓�,
Address
)
(City Town Vlllagej (Zip Code) (County)
Identification of Source'
Sam tin PotwithP i 1. z
11 Refrlg ®rated . ~
r
Chlorinated? Yes No Free mg/l, Total mg /l }_ pH
RESULTS DF EXAMINAI tON QF W4TER
P /4%100 ml F MPN /100 ml
3btal Coldorm 4To -.
fal Coliforrn
E. Col 4. F
Fecal Coliform
Standard Plate Count Other t
Bacteria Per ml (48 Hr)
r.
These results tntlicate sample (was, was not) of. Y Reported by " Date:
satisfactory quality when sar�tple was collected - Ann Mare Bury
Stanley Lander
Box "L"
Amawalk, New York 10501.
JOHN KARELL Jr.. P.E.. M.S.
Public Health Director
Re: Application: Langer
Street: The Far Reach
Town: Putnam Valley
Fee Due: $200.00 CERTIFIED CHECK OR
i MONEY ORDER
Dear Mr. Lander:
This department -is in receipt of the above referenced project.
A review of your application will not be made until this, office
receives the required fee.
V y tr ly yours,
John Karell Jr., P.E.
Public Health Director
By :s iKfine 1 n
i tine John
Intermedi l/Clerk
JK: CJ v
Encl. Your clients check in the amount of $200.00
a
Owner or Pur4haser of Building unicipality
G �/c.
Building Constructed by S =sn P
Location'- Street Block
N"E'SiLliFr' 7744. -
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 :rude 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 the system to operate was caused by the willfu or negligent
act of the occupant of the building utilizing the system
Dated this day of 19 ?f Signature
Title
If corporation, give 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
NORMAN ANDERSON INC.
WELL DRILLING
R.D. 3 Barger St. Box 244
PUTNAM VALLEY, N. Y. 10579
914 LA 8.8698
MR. RICHARD LANGER
off CANOPUS HOLLOW ROAD,
TRAIL OF MAPLES (FAR REACH)
PUTNAM VALLEY, N. Y.
• 1,3579
TERMS
DATE
3 &43ER 13., 197� 17)
NUMBER • .3 0
10 0
a C) D
0 0 -:J 0 -D
D .0. • 1.10
PLFASE DETACH AND MIZT.MN WIT. YOUR REMITTANCE
DATE CHARGES AND CREDITS
BALANCE
BALANCE FORWARD
3051 221 casing 5 gallons per minute 6/22/7L
$ 1874.1
Received on account 4/29/75 $200.
ff 11 it ' 9/2/75 500.
5/15/77 300.
-----------
$11jo. -
Balance due $ ---774.1
0!J #0 0 0
0 ON 0 '-
3E) 00Q-0
10 - 0710:0
10:1110.
woo -060
NORMAN ANDERSON INC. PAY LAST AMOUNT
IN TH IS COLUMN
WELL DRILLING Za"CY&W
9
i
.. -.s .v..yr.r.• ,. . , ..,. _a. f. �. .._ _ %aw a_ <: =... ;•.- :>,a...s �:- -r -OT o . �c.. -.. ,...s �.,.._ .. f� .:.. .. a. ,.a .,.. _ u. ..,.. .. u. _.. �.,,c .. ,._.. .._ ..o., .c.
Owner or urc aser of Building Municipality
wcm�leJ LAS, tlt
Building Constructed by A-,, /
''Eat
Loc �v
�atiofi - Street Block
Ae5ia ?I&L 41-�
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-
-- vic- es--of the- :- Ru!-t -nam. Go- u.nty- .D-- partmt t- - -o -f- deal- t-h-- as -.to- wh- e-ther .or •not- -tha _ .-
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the syste
na re
Dated this % day of 2 19 � 1' Sig to ,,��. -- C • Title
71 If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMK 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
AA l� G•4niCw,' OI�J,tf c° iv4,sr qtL
Owner or Purchaser of Building I�unicipali'ty
-c"R D Y4,V r e ft
Building Constructed by
Locatidn - Street
Building Type
(
Block
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-
- vicar of the• - Putnam- County ° °Department "of HealtYi'. as" to "vliethe'r' or ndt" the
failure of the system to operate was caused by the willful or negligent
act of the occupant. of the building utilizing the system
Dated this % day of 2 19 ?2- Signature
Title
If corporation, give 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
:1
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