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BOX 22
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02538
P.V. g_81
C� PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
Y�TECOA>CCEiiFiGATE °�;F��.iZSTRUCTI ! d Vlc FOR- SEWAGE- DISPOSAL= S�. ..
- �CR•!!Qe,�+�..:, ....(.- 3/_ .:. :....:........... ...
1 •n� n
Tow n
�L(,�tL • Tax Map "9V �P
Located a Block
--��t----��
Owner +LLrtiS C�-��i /� /� u Lot �J �j� Job
Separate Sewerage System built by —WQ,6 AS • "'C'�E �- / Address 13 91<i ` "� o /oN -Mos %
Consisting of l000 Gal. Septic Tank and 421 L F oi= 2.' wim LEA641t/ r5 151a -4D_S
Other requirements
Water Supply: Public Supply From �/ l c
Private Supply Drilled By 140QAAAN fyJ)' -��7&
Address ST_ PUIWAM LL `
�/� �t n
Building Type � No. of Bedrooms Date Permit Issued
Has Erosion Control Been Completed?
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 perms issued by the Putnam County Department of Health.
Date
SS t40V—`tA13E-Z- , -/ 1 Certified by o
J eA P.E. R.A
tAU!:-..o6-r NOR--"
Address iJ /Y ` License No.
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 C sinner of Health, such re on, modification or change is necessary.
Date
1' By Title
- PUTNAM COUNTY DEPARTMENT OF HEALTH
_. - .............- - .... Divisiun - of Environm'ental' Health-Services,- Carmel,'. N. Y" 70912`_.. .._..... D _ . v .. .....�
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Towrr or Village
Located at Silleck 81 1Vd Tax Map 29 -2 -5 &6 Block
Subdivision Osc 7ana Acres Lot Job 81 -118
Owner Thomas RAcek Address 1-3 High Road
Building Type 1 ifamily residenCEIt Area 0.75 acres Monstorse, N.Y. 10548
Number of Bedrooms —4— Design Flow 600 GPD Total Habitable Space 1500 Square Feet
Separate Sewerage System to consist of _ �' 000 Gal. Septic Tank and 400 1f of leaching' fields
To be constructed by not Gel ncted Address
Water Supply: _— Public Supply From
Private Supply to be drilled by nOt selected
Address
Other Requirements
I 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 of e Putnam
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 he original Sys te r 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 ins all in accordant with the .Stan rds, rules and regula iions of the Putnam
County Department of Health.
Date 4110181 Signed
P.E. R.A.
Address aC N.Y. 10fny License No. 11056
APPROVED FOR CONSTRUCTION: This approval expires one year fr the date ssued unless construction uilding ha s been undertaken and is
revocable for cause or ma be amended or modified when con$ eyed n cessar by a Commiss' r of Health. han a or alteration of construction
��� 9
requires a new oertnit_ Aoornved_fnr disnnsal of dnm.. .Ci L Un RR1rJ�cA.wan4vnr1 — nri...t. .r e._�..•r!v
L3
Gentlemen:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date •:
Re: Property of Thomas Racek
Located at Silleck Bllvd
Section 29 -2 -5 &6 Block Lot
This letter is to authorize Joe'1 •Green'bercr
a duly licensed professional engineer or registered architect
(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
L:viteiec Liw, wl Ln U"S Ma is i.ei• a;iLi to. supervise ine 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-
tar,y .. Code
P.E., R.A., # 11096
I•: ;: a •• ►• •
Mahopac. New York 10541
914 -628 -6613
Telephone
0
Very t yo s,
Signed
Owner of Property
1 Road, Montrose' N-Y. 10548
Address
914 - 739 -3880
Telephone
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT, MUST.- FzSU BIM ITT E En ,ITI,SIN::30 DAYS_O.F_INF.LL. -COMPL E T6OS.•
OWNER
NAME
THOHAS RACEK
ADDRESS
SILLECK DRIVE, PUTNAM VALLEY N. Y., .
LOCATION
OF WELL
(No. 8 Street) (Town) (Lot Number)
SILLECK DRIVE
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ E TABLISHMENT ❑FARM ❑TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (SPeif l
DRILLING EQUIPMENT
� OTHER
ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑
CASING
DETAILS
LENGTH (teat)
38 '
DIAMETER (inches)
6tt
WEIGHT PER FOOT
15
� THREADED ❑ WELDED
I PBLVE SHOE
X TES El
IX
CASING
IYES D NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR
t
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST fleet)
Depth of Completed Well
in feet below Land surface: #320'
SCREEN
MAKE
LENGTH OPEN TO AQUIFER ( feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (inches) FROM (feet) TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION.
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
1'
28'
OVERBURDEN
m
'Cr D
DEC 3 1981
C)F HEALTH
28'
320'
bedrock GRANITE•
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
DATE OF REPORT
WELL DRt;LLER (Sigh' ature
Al. /
YORKTOWN MEDICAL LABORATORY INC.
'P:O. Box 99 321 Kear Street LOCATIONS:
=21 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203
Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777
24 32Q3 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 3335
.::.:�,........__. -. _.�.. x- _. .._....,... -❑ ST0NE r- -IGHAJE.(NEAR. CIO. SPIT A" L);CA'RK4EL;N,:_Y.;_051-- Z:2..7 1,330,.
LAB # HV #1050
DATE TAKEN: 11/18/81 (6:15 P.m)
r– DATE RECEIVED: 1119 '81 (12 :30)
THOMAS RACEK DATE REPORTED:
SAMPLE SOURCE: IAUNDRY TUB IN .
SILLECK BLVD. BASEMENT
PUTNAM VALLEY, NY 10579 REFERRED BY: CROSSROADS PHARMACY
L
I
7:39 -3880 LABORATORY REPORT
mg /L
COLLECTED BY:
❑ ACIDITY ............................ .............................:• ❑ ALUMINUM ................................ ...............................
❑ ALKALINITY �% ❑ ANTIMONY • ........................... ...............................
'12� BACTERIA, TOTAL /mL ............. ..... ............... ❑ ARSENIC .................................... ...............................
• BOD, 5 DAY ............................ ............................... ❑ BARIUM ........ ............................... .. .. ...............
• BROMIDE! ...............:............ ............................... ❑ BERYLLIUM ......................:......... ...............................
❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ...............................
❑'CHLORIDE ............................ ............................... ❑ BORON . _... ......
❑ CHLORINE .............................. .......... ❑ CADMIUM ............. ............................... ...................
❑ COD .....• ............................... ............................... ❑ CALCIUM .................................... ...............................
❑ COLOR ................................................................. ❑ CHROMIUM (tot.) ............................ ...............................
❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ...............................
❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT ......... :.........................................................
❑ FLUORIDE ............................ ..... ........................... ❑ COPPER ...................................: ...............................
❑ HARDNESS ........................................................... ❑ GOLD .......................... , .......... ...............................
❑ MPN COLIFORM COUNT / 100 ml ......../f ................. ❑ IRON ..... ............................... ...............................
>9ffMFT COLIFORM COUNT/ 100 ml ....10 .................. ❑ LEAD ........................................ ...............................
❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ...............................
❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM ................................ ...............................
.._ .- '-0- N4TI10GiE-N -! KJELDAHL.-- r::.-:: zr :::r..:,.::r..,, .::.........::: , ----❑= MANC-- AN.IrSE...- ................. .............. .... ..
❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .. .............................. ...............................
❑ NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ....................................... ...............................
❑ ODOR ................................ ............................... ❑ PALLADIUM ................................ ...............................
❑ 61L & GREASE ....................................................... ❑ POTASSIUM ................................ ...............................
❑ PH ............... :..... .............. . ............................... ❑ RHODIUM .................................... ...............................
❑ PHENOL ❑ SELENIUM .... ...............................
❑ PHOSPHATE (ortho) ................... :........................ ... ❑ SILICON .................................... ...............................
❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ...............................
❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ................................................
❑ SO.LIDS, SETTLEABLE, ml /L .... ............................... ❑ TIN .............. ............................... Lot A 54V-750
❑ SOLIDS. SLiSPENDED ............. ............................... 0 ZINC .............................................. ...............................
❑ SOLIDS. DISSOLVED ............. ............................... ❑ .................................... ............................... �S..
❑ SOLIDS, TOTAL ..................... ............................... ❑ ............................................................ Du ..... 3 ..I
❑ SOLIDS, VOLATILE ................. ............................... ❑ REMARKS: .................... ........................^;... ........ ....
❑ SPECIFIC CONDUCTANCE ......... ............................... ❑ ..... ........ :................. ....................... .P.,.YMAPF 41 - -c u i
❑ SULFATE ............................. ............................... ❑ ........................................... ............`j�1T..O�..HEQL6E °4
0-,SULFIDE ............................................................. ❑ .................................................... ...............................
�. SULFITE ............................. ............................... ❑ .................................................... .......................:.:.:..:
❑..SURFACTANTS ..................... ............................... ❑ ............................................... ..............................:
❑ TURBIDITY ......................... ............................... ❑ ..................................................... ..............................
THESE RESULTS INDICATE THAT THE WATER WAS yFSOF A SATISFACTORY SANITARY QUALITY WHEN
\THE SAMPLE, WAS COLLECTED,
THESE.RESULTS INDICATE. THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OF .
NEW YORK. STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72).
T `ALBERT-H, PADOVANI M.T. (ASCP). DIRECTOR: _
1
7
ti
ci T-6) 1114
Owner or Purchaser o Building Municipality
TJlOMAS RA L'g,�
Building Constructed by
S t �t mac. '13L VD
Location - Street
bN-F� t--AjA_ •
Building Type
?Iva 29 '2. -6746
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.d.escribed 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-
vices of the. Putnam County Department. of Health -as towhethex._or. not_ the-.-,.-.
f- a- ilu -ra of t��E s;�iem �to operate era`s` caused' by' the willful or negligent
act of the occupant of the building utilizing the system.
Dated this 23 day of O G 19131 Signature T 15a ca •
Title OLOlVEa
(If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF MTL ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County De art o alto
VID
DEC 3 1981
aJ : •] r
� !�
DEEP C3F F�E�'aL'�
----------------
V====:V
I.VV.
KAC,L-K
Pitt
T _—SEWAGE DISPOSAL SYSTEM NOTES: DESIGN CRITERIA
1. This entire septic system w35 in- .1. 3 bedroom hou6e-1,000 gallon
stalled under the supervision of the architect precast concrete'. tank
and in accordance with the approved plan and installed.
the rules and regulations of the Putnam County 2. Soil rate. 11'15 min.-0.8 GPD
wealth Department. per sq. ft.
2, All work wz
'�S -inspect -t-ed px±or to bei�ig a. daily flow.20,0 gallon per
-
-backfilied. bedroom-200x3 bedrooms=600 GREP,
3. No trucks,machi�nery_, �bu"i_lding 600 gals. ; 0.8=F.750 ; 2 =375 L.1
nor excavated ear-,Eh %venP- - -allowed in the b. 421 L.F. of 2,1 wide-.-LEACWINC.
sewage disposal area. Construction of the .�isLj7-1c_*_. installed.
system \VZ5 in accordance with these plans;
any revisions thereto and the rules sLn� Putnam
County Department of. Health
regulations of the permit issuing Goverpzvision Of Environmental Health Services
mental Agency..
ja A_ pp� pmrocv
aebd i e a s K unloets e d a nfd o r R ecconfaotrimo a nG ' c
e o f w itthh e LOT is Putnam
Vok
-kntY Real
n 6t⁣,K ONG
-7 A
AVoU T j,"
JOEL LAWRE.NCEUR-EENBERG -Viva iqv ftVjjjT 66WAC.F I'9 5PVSAL A'P T j
ARCHITECT - TOWN PLANNER. -TOM r2ACF-K-
FZR # 8 MUSCOOT NORTH 6iDuLcv,4PLv SD_ sIti4CGK_ a
MAHOPAC� NEW YORK 105.4
a.
RAI y
gw.,( w( , 1.3
No 4 a u—S L,
IKO
Ij
:WILL
R r
"KENED
E 0 3 1981
cou�VTY
le. . � e
L)EJ,T. OF HEALTH
4 jurznom bares
4
n 6t⁣,K ONG
-7 A
AVoU T j,"
JOEL LAWRE.NCEUR-EENBERG -Viva iqv ftVjjjT 66WAC.F I'9 5PVSAL A'P T j
ARCHITECT - TOWN PLANNER. -TOM r2ACF-K-
FZR # 8 MUSCOOT NORTH 6iDuLcv,4PLv SD_ sIti4CGK_ a
MAHOPAC� NEW YORK 105.4
a.
RAI y
gw.,( w( , 1.3
:WILL
R r
"KENED
E 0 3 1981
cou�VTY
le. . � e
L)EJ,T. OF HEALTH
4 jurznom bares
4
n 6t⁣,K ONG
-7 A
AVoU T j,"
JOEL LAWRE.NCEUR-EENBERG -Viva iqv ftVjjjT 66WAC.F I'9 5PVSAL A'P T j
ARCHITECT - TOWN PLANNER. -TOM r2ACF-K-
FZR # 8 MUSCOOT NORTH 6iDuLcv,4PLv SD_ sIti4CGK_ a
MAHOPAC� NEW YORK 105.4
a.
RAI y
gw.,( w( , 1.3
_rTo
AE
LOCAT.1-0.
Putnam County Departmont 0-f 1jea).th
DIvislon of Environmental 11ca7tit 5'0rV11Q011
Approved as rot ,�k f vilth
il [1- U Ono of the
4K
of NE N
CA
SEWAGE DISPOSAL SYSTEM NOTES:
DESIGN CRITERIA
T. This entire septic system will be in-
1. 3 bedroom house-1,000 gallon,
stalled under the supervision of the architect precast concrete tank to be
and in accordance with the approved plan and
installed.
the rules and regulations of the Putnam County
2. Soil rate:,11-15 min.-O.-8 GPD
Health Department.
2. All be inspected being
per sq. ft. 33 .
daily
work will prior to
a, flow.208 gallon per
backfilled.
bedroom-200x3 bedkooms=600'GPD
3. No trucks,machinery, building materials
600.gals. ; 0.8=750 ; 2 =375 L-im,
nor excavated earth to be allowed in the
b. 400 L.F. of 2',11 -wide -1 swcz
sewage disposal area. Construction of the
_-PJELry_-.._.to be installed.
system to be in accordance with these plans;
any revisions thereto and the rules.and
regulations of the permit issuing Govern-
mental Agency..
LOT is
No yno-se LOT 14.
ho qov5c
RZ) P T ff-
4
Tts
WELL
A
14T
P,
UT V)
se
40,
0
Of 0
Lr oo.eAL JUh4TIoN sores sores
Un
Lij
74
. ob
N 27, v" o/0"VV I 5.1'b''
T�CA_l I -(�r-
VXP— N - T
6 1
LAVE OXA0VANA A,;rLEI)
6 r4T]";5m ONE
mAr -7 A
t,_t_WA6F_ D.SP06AL T
A4 L5t 16,
JOEL LAWRENCE GREENBERG
PAT6
wc No.
;,LoJwT 0
ARCHITECT -TOWN PLANNER
"AMC.
rogy—
I
*
TOM '12 A r-, F— 'I
RR # 8 MUSCOOT NORTH
H6,
1
f__
MAHOPAC, NEW YORK 10541
Izav
-SD-
51 L L E (_ K_ bq LE V/+ f1C;)_
(914) 628 GG 13
MTN AM Vy' - j NVW
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
G.OUNTY.: OFFICE- BITI- LDING,•.. CARMEL; -P1::: y.;:.:.;.10512.,..
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM
FILE NO.
Owner Thomas Racek Address13 High Road, Mon-rose' N.Y. 10948
T.M.
Located at (Street g�2
�g� flock Lot
n ica e nearest cross street)
Municipality Town of Putnam Valley. Watershed Hudson River
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
",Hole
Number,
CLOCK TIME
PERCOLATION
PERCOLATION
Run.
No.
Start- Stop
Elapse
Time
-Min.
Depth to Water
From Ground Surface
Start Stop
Inches Inches
Water Level—
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
#1 113:00
€3:33
33
16
19
'3
'13/3 = 11
28:34
9:07
33
16
19
3
33/3 = 11
39:08
9:41
33
16
19
3
33f3 = 11
49:42
10:15
33
16
19
3
33/3 = 11
:02 1-8 :OS.
A —48
33
16
19
3.
-4 -f-4 -:`11
2B:.39 9:12 3 3 .: _ 1.6 . 1.9.... ._- ._ -- -33/-3- -
A:13 9:46 33 16 �.9 3 3323 =" 11
4 :47 10 :20 - 33 1 6 _ 19 .3 '13(3 .11 .
4
5
Notes: 1) Tests to be repeated at same depth until aDnroximately 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.
Address RR#8, Muscoot North .L,
Y, 1-0541
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: op NEB
Soil Rate Approved Sq. Ft /Cal. Checked by Late
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS. NC:OUNTERED.IN'TEST:HOLES
DEPTH
HOLE NO. HOLE''.NO. -':. ^NTH HOLE NO. PTH
G.L.
T- op Soil Toxi' Soil Top -Soil
611
Sand. Small Sand Small Sand. Small
12"
stones& Some clav stones& Some Clay stones& Some Clay_
4 if
30.
36..
42"
•
6011
It _
66"
it
7211
l8fl
it
84
It
INDICATE
LEVEL. AT WHICH GROUNDWATER IS.ENCOUNTERED
INDICATE
LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
.TESTS MADE, BY .Joel Greenberg Date Sept_ J-7 I ggO
Soil Rate
Used l l- 15Min/l Drop: S.D. Usable Area Provided 5,000. S.F.
No. of Bedrooms
3 Septic Tank Capacity 1 000 b Pebrecatc nc•
Absorption Area. -Pro ded. BY _400 _L..F.x24" .. *. rench
er
Address RR#8, Muscoot North .L,
Y, 1-0541
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: op NEB
Soil Rate Approved Sq. Ft /Cal. Checked by Late