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02475
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:PUTNAM CO:
U Division 6f 67
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1M� LL COMPLETION' REPORT.,' I i ;I i; ; I ! PUTiN/AM COUNTY ®EPARtQl1EMT: OF FOEAt,TM
Division of Environmental tiealtII Services
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1 � l � t; , ff , i f ° COUNTY OFFICE .BUILDING CARAAE4, NEW YORK
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? ' ,; his''�pbr ,ts ba. mplet d by��vell,;�ril�er} ih6 submitted t6 County Health bepartment together with labore�oty report of
1 iI +I, l 1Itit i,.� �, t tl .,,
j!lpyi I, ne lysls�of?weter sem let Vindicating water is o sa isfactory bacterialiquality foe cerYtficate,(if consuuctlori cOmpli ®nce is issued.
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! ,t 1 EPO iT MUS'i BE S,UB ITTED W17FIIN1`$Oi0/11/S t0 WELL ;COMPLETION . Jjt
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if yield wet 4etfed of diAerontl doptlia during d dhng, list below!
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ADDRESS '
®wNER'
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LOCATION (
(No. 8 Street) (TOwn) (lot Number) ,
OF WELL: O
O S E gl tS JR6ND P PT4 1. 1�
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PROPOSE® ®
DOMESTIC ❑
USE OF
WELL P
PUBLIC AIR 3 OTHER
❑ S
SUPPLY. INDUSTRIAL a
DRILLING O
COMPRESSED + CABLE
EQUIPMENT. R
ROTARY, .,,
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HMEASURE +F OM il'AND SURFACE TA1lC(Spe fly feet► I
IDURINO YIELD; TEST (feet) D
De th of Corn leted Well
11 , 1 M
MAKE •' ° ` L
LINDY OPEN TO AQUIFER (fee ,l
SCRCEAI .' . ,
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T_,f!
SLOT SI! E , i D
DIAMETER (inches) IF GRAVEL D
Diameter of well including G
GRAVEL 31ZE (inches) F
FROM (10sy T
TO (1001)
PACKED! , g
grovel Pock (inches): I
I�
DEPTH FROM LAND SURFACE S
FORMATION DESCRI ION t
Sketch enact location ol.well with distance$, to at least
'' FEET. ;to FEET I
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1-FR tStanature) .,/ /
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PEEKSKILL MEDICAL LABORATORY
d
1879 Crompond*'Rd. Barclay Plaza Bldg. A, Apt 1
PE 7-8777
Peekskill, New York- '10566
DATE COLLECTED
RESu LTSQF EXAMINATION OF WATER
OWNER DATE RECEIVED
OC
L C
DATE REPORTED
E TOWN 6 /O NAME AME OF SUPPLY
sB
CITY, VILLAGE;
oe"J
C /*
cA 11l CA
0�c A-
SAMPLING POINT
BAC'T'ERIA PER ML. (Agar plate -HARDNS, TO
count at 350 C). COLIFORM GROUP (Most probable
ES TAL - ppm
DETERGENTS - ppm NITRATES IRON, TOTAL - ppm
(as N) - opm
fl-OURIDE (F) mg./I
water was
These results Indicate that the'
tS of a satisfactory sanitary quality when the sample was collected.
,
A. H. PADOVANI, M. T. (ASCP)
W.
caner or Purchaser of Building Muic p lity
��--,
u ng ons r ue tE by
/
L ®ca on` tr ,Oat-
Aulding 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 follo *.sing 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 Environrrlental _Health Sera
vices of the . Putnam County .Department of - Health a•s to whether; or not .th ®
failure of the system -to"" Operate - wds_ caused 'by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this day of 19 Signature����
Title
( corporation, give °name
and address)
-• - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3). COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS. BEFORE
CERTIFICATE OF COMPLETION WILL HE ISSUED.
GUARANTOR IS RE i? TO FILE NOTIC3 OF RA
_TB OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of..Health
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REVISIONS
GEORGE A HAUGMIV:EY, P AT° � U.
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CONSULTING ENGINEER
,sy
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n.�
Route `52 — Garmei 'fVew 1!ork 70512`?” y
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TITLE:.
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C_QL//$7 ���vRf4 !'V`,`:j= "/f�:''W /r};,
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_ - - STAN PR; 'PRQOUCTS-ligc.,PQRS YJL7N1 L7Qf�',�t:{rJ" ,. 1
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` PUMAM
COUNTY,-DEPARTMENT; ®F ALT
of Ewronmental'HealI Servi l
k.. Y 10512
CORISt G%UCTIOU PEI;flN &Y FOR SEWAGE D6SPOSAL
:+ t r _ �,1:K19. r^ i7iiid9 ,- °e''��""'c�'a..•- �+.�..- "".,
Located at '. Block -' 4
Subdivision Lot ob' ,
} Co,
Owner Address
Building Type -0�� Lot Area
Number of.Bedrooms Design Flow Total Habtable 5 ace Sglaare feet
- ,�
Separate Sewerage;System -t co-nil t of " Gal Septic Tank and
S.
Y
To be constructetl b T Address
Water Supply Public Supply From
G� / g�yypp
Private Supply to .be drilled by J (/!1,
♦k i
r Address '
Other Requirements � s - -
I represent that I am wholiy`and completely responsible for,the design antl location of -the proposetl system(s); 1) that the separate sewage disposal system
4
above described will be:consfructed as shown :on the agproveC amendment thereto and-,in accordance with the standards,.rules an - regula ions,o _ : tole u riam:
County _Department of :;Health, .and thaton: completion thereof a Certificate" of Construction Compliance satisfactory to the Commissioner -of. Health.will _
be. submitted -ao ,the Department and a written `guarantee will be,furnished;the`owner his'successors; heirs or assigns by the builder,:that said builder will'
place in good operatingyconddion any`Pair of said sewageldisposalsystem during.the period of two .(2) year.S immediately following,tliedate_ of the:.8ssu
ence of, the approval of the Certificate of .:Construction Compliance_of }the or al''system or any repairs thereto 2) that the;drilled.,well de'sEribed above:
wil
I,be located as Shown onfhe approved plan and that saitl well will be install accordance with ,the standards rules: and raga a ions of `the Putnam,
County D actin t of Health s
Date Signed P. RR�.
Address License No.
+ :APPROV:ED FOR CONSTRl1CT101V: Tfiis,.appro4al`expirii one year from theAzdate issued unless construcLOn- bf the building has been• undestakero and is
revocableYOrtcause or may be amended or modified' when considered necessary`Rby the' mmissioner ;of Health, qny, change or,a)te4 ion of - nit ruct0ron i
uirw a new permit Approved for+ disposal of domestic "sa y sewa e, and or pr a e wa er supply. o y
�r 7 e —
.Y Title
C9 '
�/.
m
rTrA .r.,. s :r..�J�r :rr1::>>>Ec���:rc�rr,
Prop::r. ty lines or corners found '. , .
Can estijmat-, hou.so location'.. • 9 ✓ _ _ - -_..'-
1 1.11. drivei,,ay n^ed cut , ,
Mhis: t trees be remove =d -note thvice 0 r• - -- — ___.___._ .
is deep hole representative of entire STNS area
Additional dc,,--T) holes no-eded. .. .✓
Su1'f i.cient SDS area available cons:i.deriiin-
driveway • cut, house location, sopar.ation .
distances., etc • ' • a • i'i •
D E, .-E P I10 LE DA, r,"'A
I�:pth :
1-later elevation: r1oN0-
),cock elevation: No #J G"
Soils description: .*cA • 4& s1rS SaLeaM
Da to
F-TNAL SITE RISP CTIODT Insp. by:
}rouse located t-ffier.- shown on approved plan
SI�"> loca.ted"where appro .-d -
�.i•:.., -ice .. +• .- ....,,...., _............. .. .. _. � .
Slope of tile lire � and* tr. ench acceptable
Room allowed for expansion t1renches _ Over 50 ft. from st•;amt),vatercourse -"
Natural soil not stripped or SDS area
- unn�ces•saril;� .,r, -raded .... . .-_.e: - ".: �: _a ..._. ..: . _ ._ _ .. _..;
10 1 ma- intai :ed from prop.line and
20 ft. from 'Llouse
Separation of trench from ,house, well -`
etc., follows plan •
Nwiiber of bedrocms checks •.
Stcnes, brush, Stumps) rubble, etc. 'greater - — --
tl)an 15 ft • from near °st trench . . . • • •
15 FL • of peripheral soil horizontally from _
trench . . . . . •• . . . . . . . . . .
Junction boxes-properly set
Could surface run off from driveway, roads, .
ground surface, etc. channel ' noar SDS .. .
area . • • • . . .... - • .. . • . • _
Dc)--s 16t d r. ainat~e aprear O.Y.. in area of: SDS
I►1I1ALL GRl1DING OF SITE ACCEPTAIlLE ti
PUTNAM COUNTY DEPARTMIT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of Mr. 'Richard:Anderson
9�
Located at �'�c� c , ��. ° P •
Section Block Lot
Gentlemen:
This letter is to authorize George A. Haughney
a duly licensed professional engineer X', or 'registered architect
(Indicate')
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 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 Ior systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
,tary Code.
Very truly yours,,,
Signed
'Owner of--'Property
of ✓ roG�,` i � � � E-��, � / t +-� ' J`�y�
Countersign s "clb Address A(I
P.E., R.A., `/
Telephone
Route 52 °'P`S�6�a1)
............
AMress
Carmel, N.Y. 10512
(914) 225.9353
Telephone
PUTNAM COUNTY DEPARTMENT OF lily. ?1LTli
DIVISION OP Evv'V1R0NT•,ff 1D1TAI, HEALTH SERVICES
COUNIT' OFFICE, P,11:f.L- 71P4 , ; CA}�Ml?L,L N.
DESIGN DATA SIIF-T- SEPARATE S54AGE DISPOSAL SYSTEM FILE NO.
Owner /1�_1Lry�� Address
Located at ( Street qec B1 Lot
n i.ca -e 'r1gaY0,3t cross street)
Municipality
SOIL PERCOLATION TEST I
r
Water{ly hed
TA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIPS;
PERCOIATION
PERCOLATION
Run + apse
No.' Time
Start -Stop Min.
Depth, o -;dter
From Ground Surface
Start 'Stop
Inches Inches
ater ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
1
4 .
5 -
`j
2
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 De subuitte'd
for review.
2) Dopth measurements to be made from top of holo.
TEST PIT DATA REQUIRED TO DE SUBMITTED i•ITTIT APPLICATION
DESCRIPTTOI'd OF SOYLS 1,11COUN'I.'ERED IN '.' EST II01,13S
DEPTH HOLE. NO. HOLE NO HOLE NO.
G. L.
6"
12"
18"
2411
3011
361►
42"
`t 4811
5.411
6011
66"
7211
78"
8411
INDICATE LEVEL AT WHICH GROU-M WATER IS ENCOUNTERED
INDICATE IMEL TO CH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS -14A DE BY. �. _ Date_^_____ -
. _. .
DE =G
Soil Rate UseQ�_�Min/l "Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity Gals. Type
Absorption Area Provided B�_L. F. x2I± �j6"— wid 411 ,Py�lc
1
Name Signature
Address SEAL''
a CJ.1
THIS SPACE FOR USE BY BEALTH DEPART14E11 T ONLY;
Soil Rate Approved Sq. Ft /Cal. Chcckod by Date
PUTNAM COUNTY DEPARTMENT of 1iJ?,I1LTli
DIVISION, OF E-NVIR01\7ME`ITAL IMINN SERVICES
COUNTY OFFICE BUILDIrIG, CARMEI.,, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILE N0.
14 Owner S Aaaress
Located at (Street Sec. Block Lot
n i ca1 e e es cross s rye
Municipality
SOIL
Watershed
1 TO BE SUBMITTED WITH'APPLICATIONS
5
•
Hole
l
.
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
Depth. to I%,A -er
Water Leve
No.' Time
From Ground Surface
in- Inches
Soil Rate
Start -Stop Mina
Start Stop
Drop in
Min. /in drop
.
Inches Inches
Inches
1
2 s
doe/LtC- AMP.
A04001774W#1-
5
•
l
.
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 moasurements to be made from top of hole.
TEST PIT DATA 11EQ(JIR ,D TO DE SUM'. "I:TTED 14-1 -TH APPLICATION
DESCRIP7 014 OF SOILS 3",1'MO11N'J ; ,1;0 IN `'i'1 S)T ITOLES
DEPTH HOLE . N0. HALE N0. :. .... _.H.OII:;. NO..
G. L.
12" �®
18"
24"
3011
36"
42".'
481
60"
66
72 fl
78"
8411
INDICATE ',LEVEL AT CIi CtROUPID WATER IS ENCOUNTERED
INDICATE C V1A E LEVEL RISES AFTER BEING EWCOUNTE i
TESTS I40E BY _Date
DESIGN
Soil Rate Used Min/l "Drop: S.D.-Usable Area Provided
No. of Bedrooms Septic Tank Capacity Gals.
Absorption Area Provided By L.F. x24" 3b ,��' wgdt' icy tent
Name Sign
Address SEAL'' 3
THIS SPACE FOR USE BY I.EAUM DEPARTIJENT ONLY: °��a,,, +► +'t`
Soil Rate Approved Sq. Ft /Cal. Checked by Dote