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BOX 21
02483
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02483
,COUNT'
X_ bmsio;
V F L" NdEI_,OdRn
Located ,at -IC T&-:0 -'CONST13UCTION CO, FL
<'A W14WA
ad sewe'ra System built by :rij
g!
Consisting of Gal. Se'p t Ic- Tank
Other .:requirements
--,Mater,SLO Pybk,S
yjoplV Fr om
Private,SUpply Drille�d .,
14
pAgq ress
Isuilding, Type JA J_ .
Flas kr qvion Con ro Been m Completed ?”
i certifyjhat the sy ste* nsI. as fisted serving the p, b ove.pre , l
attached); and in accordance with the -standards,:,iules
Add r'ess
he a6dv e sy : P , :
Any person occupying, premises, served 'by t
conditions resultirij :from
such 'u' sa,g,e. A P
p!oV. P
l,T ,f ,
Jh
available and the; ipiioval of the prWzte* wateKsuJply,s
ha
suoj e t? t6 ,modi ii�ation .qrq N ange,when,� n th e"qggme
t .
Date By,—
0
of Bedrooms Date Permit-- I ss0ed
7,
_V
,,,,as: shown on: the plansW he. -�
C(in�pIieted work (Cob.IeS. of which are j
is Putnam, county -nDepajrtm,en,t of Hqalthi
Licens8,N:o
su' -action as-may ,be.necessar9 to secure the'coriection of any ,unsanitary.,
all become null and void as on as a-pu6illc sanitary sewer becomes'.
hen -,,a, supply pmds,a�illable.i * ' '-SUch.�approvals,,ai,e,:.
r' f Health such revocatio q icatlon'O�i change` is necessary
s
I-_ J
,DEPARTMENT
&/t Services „.,_,, tin N."LY"10512
Z
6
34
Town"or Village
Map
'BI
of Bedrooms Date Permit-- I ss0ed
7,
_V
,,,,as: shown on: the plansW he. -�
C(in�pIieted work (Cob.IeS. of which are j
is Putnam, county -nDepajrtm,en,t of Hqalthi
Licens8,N:o
su' -action as-may ,be.necessar9 to secure the'coriection of any ,unsanitary.,
all become null and void as on as a-pu6illc sanitary sewer becomes'.
hen -,,a, supply pmds,a�illable.i * ' '-SUch.�approvals,,ai,e,:.
r' f Health such revocatio q icatlon'O�i change` is necessary
s
I-_ J
BACTERIA PER ML. (Agar plate count at 350 C).
4
COLIFORM.: GROUP .(Most' probable No. /1OOinl.)
LESS THAN 2.2
IIARDNESS ; XOTAL = ppm.
DETERGENTS -ppm
'NITRATES (as N) , ppm.
;IRON, TOTAL ppsa
WELL COMPLETION REPORT
3/71 e e
PUTNAM COUNTY DEPARTMENT 01= HEALTH
Division of Environmental Hoalth Sorvicus
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This.report is to be completed.by. well driller and Sut';',li(ted to County f fealth Department together with laboratory report of
analysis "of' water "sample`Indicating water`is'of "satisfactor'y Bacterial quality Gefore certificate'of�consti•uction compli•an a is issued ;'
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME !
ADPRESS
� /'/YG / o/l� f��/G /%� ®%je GBH' •�d''� /1�
LOCATION
(No. & St root) (Town) (Lot Numbor)
_
OF WELL
,%� .�—•
LO.S' Cri 1tJ�%/j%vr1 -e/ G�! /.j
BUSINESS
❑ ❑ ❑TEST
PROPOSED
I/1'I DOMESTIC ESTABLISHMENT FARM � V.'Ell
USE OF
WELL
❑ ❑ INDUSTRIAL CONDITIONING
SUPPLY LJ (Specify)
DRILLING
❑ (e%(
I/%J
COMPRESSED CABLE (--I OTHER
AIR I J
EQUIPMENT
ROTARY
PERCUSSION PERCUSSION (Specify)
CASING
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOL' ��11
/� ®THREADED L_1 WELDED
DRIVE SHOE
nYES NO
JV�jS 31FG
YES
MUTED?
NO
DETAILS
�
YIELD
❑ ❑ HOURS G.P.M.
BAILED PUMPED 50 COMPRESSED AIR
YIELD (G.P.M.)
TEST
=_
WATER
MEASURE FROM LAND SURFACE— STATIC(Specif IeetJ
Y
4i
DURING YIELD TEST [loot)
l
EDpth of Completed Well
feet below land
LEVEL
surface: 440
MAKE
LENGTH OPEN TO AQUIFER (foot)
SCREEN
'
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (inches) FROM (loot) TO (foot)
PACKED:
gravel pack (inches):
� I
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Skotch exact location of well with distances, to at least
two pormanont landmarks.
ici:T to rZci
/yac4e,e s
.7 AF
131" Ic- .e a c C
�1
rd
/
If yield was tested at different depths during drilling, list below
FEET°''
GALLONS PER MINUTE
�f
6
DATE WELL COMPLETED
DATE OF REPORT
WELL DRILLER (Signature) �
ai
u
r 'ur(;hase�' of build:in
o .1 I a b
� l
p r,Ii ty
... .. .... .. ..... i... .a..: nxe...rsrtcs :J ..:-M.L � T.: K: � '. . Y- ......• .. an_. . '. . a--. � a.. � . -a.T :.w[ rt .r - .--.., r
1Su— ling Constructed by
Gocation - Street
a
Building Type
e
Block
o
Lot
GUARANTY OF SEPARATE SEVAGE 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 shoran on
she approved plan or approved amendment thereto, and in accordance with the standards.
-ules and regulations of the Putnam County Department of Health, and hereby guaranty
�o the owner, his successors, heirs or assigns, to place in good operating condition
my part or said system constructed by me which fails to operate for a period of two
tears immediately following the date of initial use of the sewage disposal system, or
iny.repairs made by me to such system, except where the failure to.operate properly
LS C!iWbL -16 .ijv -che willful 61' dC i Of t-hLe ol:l:i! Pail L vi LL,i .. U A- ,A•"�i sb `•.' `—`•"6
The undersigned further agrees to accept as conclusive the determination
)f the Director of the Division of Environmental Health Services of the Putnam County
apartment -o f Health--as -to --tðer or-not the failure `of `-the -system to 'operate caas
!aused by the-willful or negligent act of the occupant of the building utilizing the
;ystem. i�
)ated. this 2 day of 19 Signature,_
•(if corpopation,,, gIve� name and address
Y
-------------- ____ __----------------- •---- - =rt�F
�
..
I'IIREE (3) COPIES -ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS' BEFORE CERTIFICATE
Ir COMPLETION WILL BE ISSUED.
UAPu1 \TOR TS RF.OUTRED TO. FILE NOTICE OF DATE OF *FIRST USE OF -SYSTEM.
I_- ----- _____________________ ___..____......_- __- _- ___ - - -___ ___ -_- __- __.:_- _ -_ -__
Iiivision of Environmental Health Services, Putnam. County Department of health
.o
°
�,'g� t Fes•" � t . '� t '' � > "".�' �r. - �:.- � ,....`�..___._,"- 'T.3"'.�'°".'�
*� _ a PUTNAM .COUNTY =DEPARTMENT OF ;?HEALTH
1 ,., /
3 Dn!is�on, -of Environmental Healih�Serv�ces 'Carmel f Y X105.12'
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM k
own or IA9e.
,ed * •�(./"�G:�/♦�Y1/' AJy+!e [a•D ''{iwhFlaw v,.'. _a•+.. `P };zy". ® r.
.. Lo ca .. „ x - � �. � �BiOCk
Subdivision Q ��07 � Lot k ' r�� � Job ,
�08 ol��lLAi _ w Address �0� yr "<ilA/C�v �QQ f 1%�
Owner ,
Building
Area _f'�ffnelGL. �1/lY' :.0 A fS- 3G 8 3
Number of 13ed`rooms al Habitable Space
Wle-
r
of
T e�yy
Separate Sewerage System to cohsist of ^' Gal -Septic Tank L%+
IF feet X
Rhea h
d b .... •: .- ' owl. ..... _.6 ... _= .,: ,1 w ,
t_ constructe Y /` �S T ✓� 5 J S
To_'be , _
,., Y Address;
rent
v4fer. Supply Public Supply From
^i
r/ Private Supply to be drilled by A
1
i%
4 ': ✓.
TM'
e uirements �• � � ,
Other..'R q
I represent thatd am wholly and 'completely responsible f f the pro osed .system( ;), 1 =that the separate sewage disposal system. j
P ),
aboveAescrib'ed .will. be. constructed as shown ori'thq app m Xt; t in accordance'with the sta"prds,'rules: and ,re gu a ons o , e Putnam
Department of Health; and that on complefi struction Com Iiancel� satisfactor 'to;,the.Conimissiorier of Health will
r County P y
be -sub to •the ;Department and$; a writtep.,gu` e s r, >,his wci essors, heirs or assigns by the builder, that said builder will
place in good `operating condition ,any :part of -.sail ge , du a period of two (2j''yearsimmediately following the'tlate of the issu-
ance- of the :approval, of the Certificate of Constru Co pFyµ {t ri` nal stem_ or any repairs,ahereto, 2) that the drilled well described above {
_W1 61 County
will be located eprtmentoof :Health approved plan and fha d' ell ante with ` he stands s Brutes and regu aa�TTfons of f the Putnam
Address p jq 3 0 4 ' 030/ License :NO. 4
APPROVED FOR CONSTRUCTION ,This approval expjres on _ date issued unless construction of the building has .beentundertakeh and is.
revocable for cause or may be amended or modifiea when.considered necessary by, the Commissiohei of Elealth. ' A'ny'.change or 6lteration° of construction'
requires a new permit 'Approved for •disposal of dTomestic sanitary sewage arid% r prrvafe water` wpply ;only
Date.__' = e;, .,t�ji�4fh7
Title
t
i
..Property lines or corners found . o . . 0 C
Can estimate house location a a C o . .
Will driveway need cut . o . . . . .
Must trees be removed -note these . ... '. . .
Is deep hole representative of-entire SDS area
Additional deep holes needed. . . . . . . .
Sufficient SDS area available considering
driveway cut.,house location, separation . , .
distances, etc. .. G G C C C 6 . c ..
DEEP HOLE DATA
Depth: R
Water' elevation:
Rock elevation:
Soils description.
Date:
SITE INSPECTION Insp. by:
House located.where shown on approved plan. ...
SD l nca,t,ed t•There approve. !
Width of t'rench average
Slope.of tile line and trench acceptable . . .
Room ali..owed for expansion trenches.
Over -50 ft . from swamp, :•ratercours.e a
l a aural soils not '�str pp�d �or . SDS: a "red
unnecessarily graded . . . o 0 0. Y
10 Ft maintained from prop. line.and
20 ft. from house . . . . . 0 a 0, a
Separation of trench from house, well
etc. follows plan . o o . a
Number of bedrooms checks . . . . . o .
Stones; brush, stumps, rubble; etc. greater
than 15 It. from nearest trench .. .
15 Ft,. of peripheral soil horizontally'from
trench .. o. C .. C e e C o C ' e U
Junction boxes proper °ly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS .
area
Does lot drainage appear O.K. in area of SDS
FINAL, GRADING OF SITE AACCEPTABLE
.I- I
z4,4 ens & )4na. &,xs
05Ca 4'xn ®
6f^ 1/1641/
REVIO,T CHECK S r ET
DOCUMENTS _ m '• ..
House plans 0. K.
Design data sheet
Peres presoaked?
Min. 30 perc test depth
Const. results for 3 runt_
D. , Hole log 0. K.
Corporate Affidavit for oU
Authorization for engineer
Letter from Water Supply i.
If variance requested -such
r
Meets Std-1 Remarks
es ; No
t ✓
I �
i ✓
vidual
appiicabie
oted on plans
apps.! N,f'
DETAILS.
if change is proposed,)
Existing contours shown show new contours)
Slopes for driveway cuts, etc. shown �-
Water.service line location
Footing drain, etc. location
Top slope, bottom slope of fill
Percolation tests and deep test pit location ✓
Septic tank size and conformance to std. - ' ✓
3 B R.' house minimum I
House setback shown I
OW O.S
H.L.1 Wal,dl• WLIALLil w i L. . 'V1 ..XAj aLlUWii i
Plan and profile SDS
All other wells and SDS closer 200'
_... shown. • or.. refere_nce..made
Property boundaries (metes and bounds- clearly show
SEPARATION DISTANCES SPECIFIED ON PIX-
10' to P.L.
20' to.Foundation walls
:00' to Nearest well .
50' to stream, march, 1:
15' to Curtain drain
10' to water line (pits
15' to storm drain
10' to large trees
0' from foundation to
5' to pipe from leader
, etc.
.expansion);
✓
J i
I
j
I -
I
I
OP
e
j
>,._c .�w._ • �.u,n.. ..PUTNAM':`COVNTY "DEPART �.�._..,.. _ Y._.k_.� ,• -�...
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property c
Located at
Date �- 73
3eett=r t4 Block r Lot dr X x 11-1410
Gentlemen: L tkNMER
This letter is to authorize AL[
a duly licensed professional engineer or registered architect
(IndicaT_e�_
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
f , iLepartllGl t G ad to sigh all rieceusary 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
.147, Education- -Law; -the- Public--Health•:Ia.w;- and-the'—Putnam—County--sank = --
tary Code.
1 ✓r /yam
ountersigr
P.E.9 •I # 3Z.%2 -0
STANO 3. LANDER —(Seal)
A A A ress�:���
24b 264
-�k
Telephone
Very truly_ yours,
Signed .
Owner o Property
Address _ `
e ep one
F�
.,�_..:..:.:...:.:..__ ...:_.�. ,. PUTNAM COUNTY -, DEPARTMENTS= OF= -HEAhTH_......_._..�
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner 'eo,6eot ' � ,6,,644 i Address 40 /Awe,/ �C`oGE d��iJ� /'E�KSiC.tef�lj�
lA P,
Located at ( Street *1nd1cate WA UA E �*,9 - Block _Lot 7
nearest cross street)
Municipality 61, z&,44y Watershed / - e9'Sk/Z6 //01 -4,0W
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
2
3
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
apse
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
%fir
3
2 1.4--a3
l4_
0
4 -7
17 20 3 9. �
3 13 /7 2o 3
1
2
3
5
Notes: 1) Te'Rts 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 REQUIRED TO BE. SUBMITTEDJMH. APPLICATION.,-
DESCRIPTION OF -SOILS' ENCWNTkR21) "IN 'TEST "ROIi5.
DEPTH HOLE NO. jPY
G.L.
611
12't
18"
fi
2411
3011
3611
4211
4811
5411
HOLE :NO. Py-
e t o 2e-
. 1 .4
HOLE NO4)6i:1-'
17
.6011 If
6611
7211
7811
8411
-MICATE- - LEVEL -AT- WHICH GRCUM,'WATER ---IS -ENCOUNTERED-
INDICATE LEVEL TO WHICH'WATER LEVEL RISES AFTER BEING ENCOUNTERED
..TESTS MADE BY 1-4A406IZ- Date 11-2-73
.::,. Soil Rate Used DESIGN
__LO Min/l"Drop: S.D. Usable, Area Provided 5; d-o-D -7-1—
No. of Bedrooms
4 Septic Tank capacity 20a Gals. Type
Absorption Area Provided By-1,36 L.F.x24" 3b" v-' width trench.
Other
EY I L ANM D
Address ftafli ffi1A1,'jRjj k �tj
- Y. 1,0'01
THIS SPACE FOR USE BY HEALTH DEPARTMENT-QD W;*,
Soil Rate Approved Sq. Date
y County Executive
P_
MW SNMONV"X�
Deputy Commissioner
CERTIFIID
DEPARTMENT OF HEALTH
RETURN RECEIPT Division Of Environmental Health Services
REQUESTED March 18, 1986
Please refer correspondence to:
Mr. Robert Bellamy Name: James S. Hodgens
Oscawana Heights Road Title: Assistant Public Health Engineer
Putnam Valley, NY 10579 Phone # 225 -3838 or 225 -3833
OFFICIAL NOTICE OF NON - COMPLIANCE
YOU ARE HEREBY NOTIFIED that. non-compliance with Article III Section 3 of the
Putnam County Sanitary Code consisting of a discharge of sewage onto the surface
of the ground was found at your residence, designated by TM 34 -1 -7.
by a representative of this Department on 28 February and 6 March.1986.
Please be advised that the sewage overflow must cease immediately. The septic
tank is to be pumped out and maintained pumped until the proper repairs are made
to the system.
It is believed that you are responsible for correction of this condition. If you
are not responsible, you are requested to notify immediately the inspector above
indicated.
Failure to correct this condition by 24'.?-Match '1986 will make you liable to
the penalties provided by law, including prosecution on a charge of committing a
violation punishable by a fine or imprisonment, or both such fine and
imprisonment, as prescribed by law, in addition to such other action as may be
prescribed. A reinspection will be made.
It is requested that a sketch of your present sewage disposal system be suhmi.tted
to this Department indicating proposed changes, if any, to correct this violation.
This information will be kept on file for record purposes. Your sewage contractor
should be consulted if you do not have this information.
It is sincerely hoped that the above - mentioned further action will not be
necessary and that you will cooperate by securing the correction of this
condition.
JK: amm
cc: Building Dept.
File
C# 65 -86
For the Commissioner
y A S,
john Karel1,`J ., P. ., Director
Environmental ealth Services
BY:
istant Publ 3q Health Engineer
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641
PUTNAM COUNTY DEPARTMENT OF HEALTH.
COMPLAINT. -OR-,:SERVICE= REQUEST RECOR
�1
JWN Putnam Valley DATE 2/27/86 REFERRED TO
V G
NO :W— 8 to
TAKEN BY _J. Hodgens TELEPHONE CALL IN PERSON X LETTER
CONFIDENTIAL
REQUEST FROM Jay Hodgens TELEPHONE
ADDRESS
ENVIRONMENTAL HEALTH: Home Sewage X Rodents Refuse Public Water Food Service
Migrant Camp Other
COMPLAINT OR REQUEST Sewage on ground surface due to excavated junction boxes left
uncovered.
DIRECTIONS: Oscawana Heights Rd. TM 34 -1 -7
ACTION TAKEN BY J. Hodgens DATE- 27 -9(0
FINDINGS spoke with owner, Mrs. Bellamy. Notified of need to correct.
FOLLOW UP INSPECTION (s)
DATE—. FINDINGS .�_ i� / /►��rNw �Z `� 7.� (,
PUTNAM COUNTY DEPARTMENT OF HEALTH
_JWN Putnam Valley .L3
COMPLAINT OR SERVICE REQUEST RECOR
DATE 2/27/86 REFERRED
is -t G
NO (o
I
TO
TAKEN'BY J_ jQdggUg TELEPHONE CALL IN PERSON X LETTER
CONFIDENTIAL
REQUEST FROM Jay Hodgens TELEPHONE
ADDRESS
ENVIRONMENTAL HEALTH: Home Sewage X Rodents Refuse Public Water - Food Service
Migrant Camp Other
COMPLAINT OR REQUEST Sewage on ground surface due to excavated junction boxes left
uncovered.
DIRECTTONS: Oscawana Heights Rd. TM 34 -1 -7
1�uYN��, IIaL� �y
ACTION TAKEN BY J. Hodgens DATE
FINDINGS stoke with owner, Mrs. Bellamy. Notified of need to,-correct.
.• _- FOLLOW UP INSPECTION '( -s) _ -- - - ,, ,-� , 9 .
DATE
C=.�
FINDINGS
DATE 3- 24- -1; C) FINDINGS LAa ( i
PROBLEM ABATED
DATE—,y - 24 -FS6 PERSON NOTIFIEL
ESTIMATED TOTAL MAN HOURS SPENT I y�
77