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02527
'CPO
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Servicos, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE. DISPOSAL SYSTEM :PUTNAM_ilA L & Y
^ .. - - ,... .. ... .. .. ^Town � ......... _ _ .....,.__. _.
Located at - h iTs k I t+L JZQ Tax Map 19-4- & 17 Block
Owner oa Y >ZO &Tr A Lot Job
Separate Sewerage System built by ANT44QN !' i Z6 Vi VA Address snou-T -Nzoow_ RD > Y PEskl..Lc. iVY,
Consisting of _4060 Gal. Septic Tank and A 0 4 F= OP C t W J DE (F-�%% •}�� S7
Other requirements
Water Supply: _ Public Supply From —
Private Supply Drilled By
/��i �AAd,,��d11r'�,e��ss L -�
Building Type MYF..1A A. �J QEj 4 +-
Has Erosion Control Been Completed?
7"
Y
No. of Bedrooms Date Permit Issued-4 - /'- go
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, and the pern)# issued by the Putnam County Department of Health.
Date / l�� Certified by P,E).j rR.A
Address us Q LVi • %. License No. S+ 0J 6
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner of Health, such revo tion, modification or change is necessary.
Date By _.... Title
\\O ? PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYS�'EMj� �,t>>�% t Ll a4��
Located at Va rV 1 4 r= /% ` W- s^° F M �f rr�� �i. �" �
Subdivision ,'] F • 1) L UE a sr�A W A N49 A QS—`rr ,
Owner AN-71 )8e &Z-6 FE T
Building Type ��(Yl 1i � J' Lot Area44 i 6
Number of Bedrooms _ Design Flow � � 'S? V
Separate Sewerage System to consist of Gal. Septic Tank
To be constructed by '07' S ALA5 0—TE °Cj �
��y7 Town or Village
Tax Map 0 / #',62 1-7 ' Block
Lot *. R67 Job j�
Address f-1!r J It 13 Rein � 1z 2 1
' rr- A :n S e-/ 4 4- , N.Y. J 041-& l�s
Total Habitable Space I A ne-) Square Feet
and �C 0 L--,F. Or ° ty/P15
Address
Water Supply: Public Supply From CO- Private Supply to be drilled by a C �' � Ei •"
Address
Other Requirements
-,71 C cI aTQi i Q'126 W
1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations or-Me-7-urn—am
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to 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 operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance With the standards, rules and regula i�`ons of the Putnam
County Depa ment Of Health,
3m sI)
Date / Signed P.E. R.A.
Address `°� License No
APPROVED FOR CONSTRUCTION: This approval expires one year the date issued unless construe ion of the building has been undertaken and is
revocable for cause or may be amended or modified when consifinviknecessary by the Commissioner of h. ny change or alteration of construction
requires a new pe, nit. pprove disposal of domestic anitar Cge. o to water s piy �^+i
r� s d '� r /�'✓/
m
YORK IYIALLAV GRAIU.
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VWED
Y 4 �
... `* T ,�,�w, .` .:1 ,. ,... x�'k� Ot
P.0 99 321, 6KiMi. Street L
fox .CATIONS
D 321'•KEAR 8T YORKTOWIV HEIGHTS N Y�"?�10598 -245- 203
Yorktown Hei lifs�: 1059 ',PEEKSKI'LL
❑ 201 BUTTONWOOD AVE N Y 10566 7378777 E
l
❑ 496 MAIN ST MT KISCO N Y 110549 666�3335r,
245 3203 a
= f ❑ 3H .AVE M 7a 0 8 933
,,,,,:: y= ,. ;
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RESULTS OF EXAMINATION
DAT,E COLLECTED
, N
OF WATER
�zt�
OWNER ss �ti ' rs tI sa <<w t a�a
,,,�, r'.L �-�' ` -. r: ,:�rR, a. ".•,
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DATE-RE ;'EIVW z
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CITY, VIL+ALAGE, TOWN 6 /OR NAMP- OF SUPPLY
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PERML (Age plate;count,ct 35 C)'
COLIFOAM GROUP(Most probe lefNo 100rn1)l
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ry,BA yG'I'AERIA
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�ID.�yE�TERGENTS mg L
NITRATES (qs N) m L
IRON TO?,GTAL ing L
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F r
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t
�rtY 'g2w h try+• .f
AMMONIA,-FREE.(as N) mg/L Y
pH
CHORIDES (mgJL)'' ,
all :<
t �. _� .•" 1 , ..,v, w
,. c kvs�+._ `S.:R =n,rns.d e
`` COLLECTED BY a J. PROETTA
iesultslridlcatethat
These the water was YES of a'satisfactory sanitary quality when the sample was G 1
}collected
PER a CR OS SR OARS PHARMACY INC . r ..:. /J l3 ` r •. ewe ._ / .':= t a /% ;;,.
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PUTNAM COUNTY DEPARTMENT QF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
;.COUNTY. OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGY DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner w E_ j j Address —M 6 UT. 1,6e'akIGL„/ )G
Located at (S 'reet OV1 �C. Sec � �ck Loth
Inaca -e neares cross street
Municj:pali:tg.! '' atershed a.�
SOIL PERCOLATION TEST DATA REQUI TO BE SUBMITTED WITH,APPLICATIONS
Role
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Water Level.
No...:;:......: Time From Ground Surface in Inches Soil Rate
Start- '2'1-top - Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
Notes: l) Tests to be repeated at same
rates are obtained at each percolation
for review..
2) D. -pth measurements to be made
depth until approximately equal soil
test hole. All data to be submitted
from top of hole.
TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED.�N TEST HOLES,
DEPTH HOLE. NO. HOLE NO.—' HOLE NO
tvame Signat e F
�� °• 0 056 O ._
Ofi NE(J
THIS SPACE -FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by D4�te_
f,.
TOWN' :OF. PUTT 1 " VALLEY
WELL DRILLERS `LEG ' AND REPORT
MPL�T IW ELL ON
I�EP4
This report is to be completed by well driller and submitted to
,�_dg,. department, together with laboratory report of analysis of
water sample,i_ndicating water is of satisfactory bacterial quality.
i j L
Well Location/ i t'!L '!LL'-
Tax Map Street - Sec. B1. Lot
Well Owner)gAU o usT• /"�oe�%� /�"a � /�Ai� �' 1� Fee, kS�-,, 11 A,1�. lo.$) j
IName Mailing Address City or Town
' Tel. #
Well Driller
Name Mailing dress City or Town
- f
CASING GN DETAILS
YIELD TEST
WATER LEVEL
SCREEN.DETAILS
i,ength ' Ft.
Bailed
Measure from land
surface
�,�
or
Purrtped Hsse'
"Static: Ft.
Make:
•
in en Bailed
Slot
Diameter: � Inches
Yield: .1�tGPM 'lor
Pumped FtJ
Length Ft.Size
Kind: f�� !�
Diameter In.
TOTAL DEePTH OF WELL ;C� F4et
_ / -,- - DELI; LOG
Depth from Give descript -Lon f%f.fnrmations penetrated, such
Ground Surface as: peat:, sift, sand, gravel, clay, hardpan,
shale, sandstone, granite, etc. Include_ size. -of .__:.. _..._
-gravel .-
g (diam
......_�etPr) and -sand ( ine, medium, coarse) ,
color of material, structure, (LAose, packed,
cemented, soft, hard). For example: O ft. to
27 ft. fine, packed, yellow sand; 27 ft. to
134 ft. dray granite
Feet to Feet
Formation Desc.rintinn
c
r�
.late Well Completed w -'V1Z jt � Date of Report
Well Driller
Signature
BZS 1 -7'7
Owner or Purchaser o Building Municipa ity
_RN 744 ®N'e P ETTq
Building Constructed by
GVP t-mg r gi- .
Location - Street
®ABC- lzdm .
Building' Type
G�2 4- 6,
Section
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 :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 !Hhvironmental.Health Ser-
vices of the Putnam County Department.. of He.al.th_.a.s:..t.o..whether or not the
fai��� e o�- t «e- s stem to --o e-rate ac
rate b the'rai'llful` or he
gent'--
act of the occupant of the building utilizing the syste .----)
Dated this. day of N 19 81 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
PUTNAMrCOUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date ,4110!
Re: Property of
Located at
Se ion o r_6' ` -Block Lots]
Gentlemen:
This letter is to authorize Aut_
a duly licensed professional engineer or registered architec t*__
(Indicate)
to apply for a Construction Permit for a separate sewage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and. to sign all necessary papers on my behalf in
4. :vA111C1't_tUJJ wi irl i_ili5 ma L Lejv and to. supervise Uie. cunstruc Ciun 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 Sani-
_. -tart' . -Cade
'C ER E O q RC
C? �F2
a, 0 �� 01 Very truly yours,
Signe d
Owner of perty
0.
Q-
Countersigne AtT, o� tto% �O S#�OU t E2D
W -Ook, . i
NE Address �°-V
P.E., R.A., # ! � �i NYC /06 -t6
M US 01 Q "Jb Telephorfe
Address
., A:iM
Telephone
i-.: :7 7
'2
ax
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Z061"S,oe-9
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t�SE
SSEWAGE D tTSAT- SYSTEM NOTES:
This s re septic system was. installed u:
the supervision of the architect and in accordant
with the approved plan and the rules and regulat
of the•Putnar,-, County Health Department.
2. All work wa$ inspected prior to being bac*.
3 N trucks maq1),�qery._-bui.1di-
Cava arth w,;es allowed in the sewage dispos
area:"
rea Construction of 'the system wZt- in accor,
with,the ' se plans; any revisions,thereto and the
rules. and reoulations of the permit issue ng Gove
Agency.
DESI* MCMI E
a
5 r- 6 iaV use -1,000 gallon
precast concrete- tank :4�0,s in-stalled.
16,20 min/'in., 0".7 gLil/s. f.
aj daily. flow .200 gal'lon per
bedroom -200x3 bedrooms = 600/0.7
gallon/s,f: -,2 857 s.f. of
-leaching 'Area requiwed.,
b. 'SM 'I.T. of V wide e tile
fiellds '4r:. installed..
A" SUFLT Lorw!&PKI.
41'
4, 44"751'047"
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N :5 4:6 45,'a,
Mo F Tr is
0 e VLI
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0
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L06,AT'a,'--',MAF
Putnam County Department of Health
Division of Environmental Health Servlaaa
Approved as n;tcd for coreormanoo with
applicable Vu'-,co and Regulations of the
Putnau Cou;t,91:0alth Department,,
Zlgna &- Title patik
JOEL LAWRENCE GREENBERG
ARCHITECT - TOWN PLANNER.
RR # 8 MUSCOOT'NORTH
MAHOPAC, NEW YORK 10541
(914) 628-6613
PROJECT, : NE:N\1 0Q"
MR I. A 740, 14Y.
L--1T A. .
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I
L06,AT'a,'--',MAF
Putnam County Department of Health
Division of Environmental Health Servlaaa
Approved as n;tcd for coreormanoo with
applicable Vu'-,co and Regulations of the
Putnau Cou;t,91:0alth Department,,
Zlgna &- Title patik
JOEL LAWRENCE GREENBERG
ARCHITECT - TOWN PLANNER.
RR # 8 MUSCOOT'NORTH
MAHOPAC, NEW YORK 10541
(914) 628-6613
PROJECT, : NE:N\1 0Q"
MR I. A 740, 14Y.
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