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02560
- PUTNAM COUNTY DEPARTMENT OF HEALTH Permit P_3 "` Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTI PERMIT FOR SEWAGE DISPOSAL SYSTEM P Town or villavu
_ Block,.
� Lot
- y�at:�on -Wa _._. .... - .._Tax• -Map � t -
Located at 2$ 27
Lake Oscawana Acres subd. lit N r Renewal
Subdivision _[ Revision —0
-'rr ((+� �a �•�•(� l Tl Q1 e n G c Lk_ -Rd- RY i� 7A �t7 t _ �tj Gf Previous Approval
owner /Address�� --��_ X10 5 79
❑
Building Type One,. Fam. Res. Lot Area _43_,4_3j SF Fill Section Only
3 Design Flow G /P /D 600 P.C. H. D. Notification Required
Number of Bedrooms 1000 Gal. Septic Tank and 420LF of leaching Trenches
_
Separate system to consist of Canopus Hollow Rd, Put. Val,NY
To be constructed by Don Heady Address 10579. �.
Water Supply:
__ Public Supply From
xxx Norman Anderson
__ Private Supply to De drilled by
Barger Street,Putnam Valley NY 10579 A --1
-- - -- — -
Other Requirements
on of the proposed system(s); 1) 1 represent that 1 am wholly and completely
as shown on the approved amendment there to and in accordance with the stand rules an separate regu a sewage
ns of disposal 1 It nam
above described will be const u
County Department of Health, and written completion
guarantee will be furnished the owner,uhis wccessors, heirs or assigns by the builder,ithat nsaidf builder w,l
be submitted to the Department, ears immediately following the date of the
place in good operating condition any part of said sewage disposal system during the period of two (2) Y
ante of the approval of the Certificate of Construction Compliance of the original syste or any repairs thereto; 2) that the drilled well described at,y. °rU
will be located as shown on the approved plan and that said well will be insta accordan with the standar s, rules and regula i of the Pu' Y
County Department of Health. . %r
Date 2/17/86 Signed _t., __._ P.E. R.f• I Or
Address MUSJC O t_. �
APPROVED FOR CONSTRUCTION: This approval expires
revocable for cause or may be amended or m�Qdified when cc
requires a nor pern�i)ti p�pproved sal of domesti
Date —.
Rev. 9 -81
PUTNAM COUNTY DEPARTMENT OF HEALTH Permit r PV 33 -83
Division of Environmental Health' Services, Carmel, N. Y. 10512
CONSTRUCTION PER'MJT_ FOR SEWAGE. DISPOSAL_SYSTEM......__. _..
Located at Watson Way_
Subdivision Lake Oscawana Acres Subs. Lot a 28
Owner /Address N. Gods en, .Bx 33, Old Chatham, NY1.2136
Building Type nn Pam, Res. Lot Area 20 00()sp
Number of Bedrooms _ 3 Design Flow G/P /D 600
Separate Sewerage System to consist of 1000 Gal, Septic Tank
,.- _.._..P.utnam...Valle-%,*
Town or Village
Tax Map 29 Block 3 Lot 2
Renewal `u Revision
Date Of Previous Approval
Fill Section Only
P.C. H. D. Notification Required
and 420LF of Leaching Trenches
To be constructed by.. lion HAarl)l AddressCanopus Hollow ow Road. Put- Valley,
Water Supply: _ Public Supply From New York 10579
XX - Private Supply to be drilled by Norman Anderson
Address Barger Street, Putnam Valley,NY 10579
Other Requirements
I represent that 1 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 an regu a ions o e u nam
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 thedate 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 regu a ill ons of the Putnam
County Department of Health.
Date ju 1 y 1985 . Signed P.E. R.A. XX
Address Muscoot No.,RFD#2,Bx 488,Maho ac,NY 1054tcenseNo. 11056
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issue construction of the building has been undertaken and is
revocable for cause or may be amended or modified when idere necessary by the ommission r of Health. Any cha or Iteration of construction
requires a new permit, p d for disposal of dome is it ry se e, and /o private _supply only.
Date __J��
By Title
Rev. 9 -81
Y PUTNAM COUNTY DEPARTMENT OF HEALTH Permit 41 PV 34 83 " '
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCW)OIV.- PERMIT.- F_,OR- SEWAGE DISPOSAL SYSTEM
Located at Watson W
Subdivision Lake QSCawana Arres SUM. Lot a 77
Owner /Address N. Godsen_j.Bx 33,01d Chatham, NY12136
Building Type 1 Fam< Res. Lot Area 24, OOOSF
Number of Bedrooms 3 , Design Flow G /P /D_6nO
Separate Sewerage System to consist of 1 000 Gal. Septic Tank
To be constructed by Don Heady
Water Supply: Public Supply From
Putnam Val 1ey
Town or village n1
Tax Map 29 Block 3
Renewal _ M Revision
Date Of Previous Approval "
Fill Section Only ❑
P.C. H. D. Notification Required
and 420LF of Leaching Trenches
Address Canopus Hol o Rd, Put. Val, NY
10579
XX Private Supply to be drilled by Norman Anderson
Address Barger Street, . Putnam Valley,NY 10579
—Other Requirements
I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system qr;
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e Arnim T
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 - u
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate 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 shogun on the approved plan and that said well will be installed in accordance with the standards, rules and regu aeons of the Putnam
County Department of Health.
,,,,July 31, 1985 xx
Signed P.E. R.A.
Address Muscoot No. , RFD #2, Bx 488, Mahopac, NY 10541LiC.nl. No, 11056
APPROVED FOR CONSTRUCTION: This approval expires one year fr m the date Issue nless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when consi r tl es y by the illi6n.r of Health. Any change or alteration of construction . "u
requires s g�pe► � or disposal of domestic pply only. "}
Date _�_� By Title
Rev. 9 -81
Rev. 3 86
`�\ V
0 C
Located
i,
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services Carmel N.Y. 10512
._ _ ... -. ' .'.._ _..-_EiigineerMustProvide- 3 -g.3
t N Y..
OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM j
own V e
:son W a y Tax Map 9 Block Lot 2 Y'
Owner /applicant Name
Melling Address
J. Cardinale
347
_ vision Name LK Q s k ap A,. Lot if 28, 2
Date Permit issued 2,L28/86'
Separate Sewerage System bnilt by Don Heady Address y ;
Consisting of 1000 Gallon Septic Tank and 3851f of leaching trenches INY 10579
61 O.C.
_Water Supply: Public Supply From Address
ors xxx Private Supply Drilled by Norman Anderson AddressBarger Street Put, /:1- P-
B�Ilding Type one family r e s ade n CAs Erosion Control Been Completed? yes
Number of Bedrooms 3 Has Garbage Grinder Been Installed? no
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the comp ted work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance with filed p , and the rmit issued by the
Putnam County Department Of Health.
Date 2/10/87 Cortifled by R.A. xxx
Address Muscoot North, RFD #2 Box 488 a op c LI 1056
o r, ill
Any person occupying premises served by the above system(s) shall promptly take such action as may bo note y to >�curo 0 o correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as roan as a pub(': sanitary Gower becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes availablo. Such approvals are
subiert to modification or rhanne when" in the iudament of the Commissioner of Hanith_ such ravoention- modifirntinn or rhnnne Is noresonrv_
!r ;
�3 PUTNAM COUNTY DEPARTMENT OF HEALTH Permit a y?� -�3
Division of Environmental Health Services, Carmel, M_ Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam .Valle -
.
Located at Wat.Son 'Way Tax Map 29 alock 3 tot 2
Subdivision Lake Qseawana Acres Sued. 1.ot # 28 Renewal _❑ Revision - E)
Building Type One: Family Res. Lot Area 20,000 SF
Number of Bedrooms 3 Design Flow G /P /D 600
Separate Sewerage System to consist of 1000 Gal. Septic Tank
To be constructed try Don Heady
Date Of Previous Approval
Fill Sectiom Only ❑
P.C. H. D. Notification Required
and 4 2P LF of eachin2 T enches fsuau
Address u n Va ev. 10579
Water Supply: __ Public Supply From
Xx Private Supply to be drilled by Norman Anderson
Address Barger Street, Putnam Valley, NY 10579
Other Requirements
I represent that I am wholly and completely responsible for the design and location of the proposed syztem(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance w itih the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compl- dance" 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 od two (2) years immediately following thedate of the issu-
ance of the approval of the Certificate of. Construction Compliance of the original system o ny
shown thereto; 2) that the drilled well described above
will be located as shon on the approved plan and that said well will be ins t in accordance the standar s, rules and regu aT ions. f the Putnam
County Department of Health.
Date June 24, 1983 Signetl P.E. R�.
Address Musc0000t North D #2 x 488 Maho ac License No.
APPROVED FOR CONSTRUCTION: Thrs aepprovsl- erzprres one year r m e date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when co d er:e sary by the Commis ' ealth. ny change or alteration of construction
requires a new permits "AA proved or disposal of domestic sanitar sewag antl pri y oni
Date!t� By Title -':.)
Rev. 9 -e1
t
rPt7TNAM:: COUNTY..DEPARTMENT...OF._HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam - Valley`
Located at Watson Wa
Subdivision kE: O cawans3_.Acx S Sued. Lot # 27
W %.A a�c—se3
Owner /Address Old Chatham, NY 12136
Building Type One Family Res. Lot Area .240000 SF
Number of Bedrooms 3 Design Flow G /P /D 600
Separate Sewerage System to consist of 1000 Gal. Septic Tank
To be constructed by Don Heady
Water Supply: __ Public Supply From
Town or i loge
Tax Map 29 Block 3 -Lot
Renewal _❑ Revision _❑
Date Of Previous Approval
Fill Section. Only
P.C. H. D. Notification Required
and 420 LF of he&tQin2 T enches
Address U n a ey,. W"10579
_2._ Private Supply to be Arilled by Norman AndiaYsl-ln
Address Barger Street. Putnam Valley, NY 10579
Other Requirements
I represent that 1 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 witlh the standards, rules an regu .ons o 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 succeaws:, 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 any re?pairs thereto; 2) that the drilled -well described above
will be located as shown on the approved plan and that said well will be in al ad In-,accordance l'w t the standards, ules and regu aTl�ons of the Putnam
County Department of Health. (\ /4
Date June 24, 1983 Signed P. E. R.A. 29L
Address MuSCOot North FD #2 BOX 488 Maho CLicense No. �7
APPROVED FOR CONSTRUCTION: This approval expores one year ro the date issued less construction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered ni nary by the C„ , mis loner osf Health. Any change or alteration of construction
requires a new Permit. Aooroved_ for disnnsal of dnmwcflr &n bwve.noianAandinr ee
f '
G
4 �J�i °Ii. TTT:TT T AA7lATT TTT/1TT 77 L�i/1DT _.
WLLL �J VL'1L LLIIVLY L \JLL VL %1
Office Use Only
DEPARTMENT OF HEALTH
* 7Ar
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREET ADDRESS: WN /vIL ! Y TAX GRIO NUMBER
WELL LOCATION
WELL OWNER
ADDRESS:
E. � PUBLICE
ig RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ' D ABAN NED .
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
USE OF WELL
1 -'primary
2 - secondary
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED —/ EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION
)9REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL ft.
DATE MEASURED
DRILLING
EQUIPMENT
0410fARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: ' )KSTEEL . ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE —L�— ft.
JOINTS: ❑ WELDED ,N�I'HREADED ❑ OTHER
DIAMETER — �, in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE7`90THER
WEIGHT
PER FOOT lb. /ft
DRIVE SHOEg.YES O NO
I LINER: ❑ YESWNO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST .....
_
- - --
O YES ONO
HOURS-
SECOND
-.
_
_..... _....._.. --
GRAVEL PACK
0 YES
❑ NO
GRAVEL
SIZE..
DIAMETER
OF PACK in.
TOP
DEPTH fL
BOTTOM
DEPTH It.
WELL YIELD TEST pumping
If detailed
METHOD: ❑ PUMPED 1 tests Were done is in-
COMPRESSED AIR , formation attached?
O AILED ❑ OTHER ; ❑ YES ❑ NO
It more detailed formation descriptions or sieve analyses
IELL LOG are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Dia-
meter
In
FORMATION DESCRIPTION
cant
ft.
it.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
WATS OTLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? O YES ❑ NO
S.TO.RAGE TANK: TYPE Alelt flyel_
CAPACITY GAL.
PUMP WFORMA 'ION
TYPE CAPACITY i
MAKER J DEPTH O
MODEL VOLTAGE 210 HP
WELL DRILLER NAME / DATE
pooRES�3 Z G � SIGrIMRIE
O sf' AV
r
A
wner 6r Purchaser of Building
Building C nstructE by
Location ,- Street
a"
wilding . Type f
Mu icipa ity
e G
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material,.construction and drair_age 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
__utiliz.ing the_ - system. _ _ - _ --
The undersigned further agrees to accept a.s 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 .willful or negligent
act of the occupant. of th building utilizing the system.
Dated this 2_ day of , 19° . Signature
Title-
(If corporation, give name
P
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE t3) 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
eorkto.wn Medical Laboratory, Inc.
" a 321 Kcar Street
a Vorkt4;wn Heights, N. Y. 10599
(914kN S.3203
Directoi: Albeq-fd Ndoa+ano k T
J-6S4770 d CAWAia*1-Ac
L:
LAB / YK.027442
Collection Station Used:
Carmel Peekskill _
Mt. Kisco Rev City.
Date Taken: /u r —f', 9/Py
Date Received:,/a-17- Z
Date Reported:l�- ia_yj,
Collected By:-a-, CA -;s-,p yl�
Referred By: �dss/�c•e�s �°id�+¢x.��r t'}!
Sample Source: ou y���� -�
LABORATORY REPORT ON. BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count per 1.0 ml t�
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Tot all Coliform per 100 ml
Fecal Coliform per 100 ml
Fec,etl us per 100 ml.
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN.- I -nde -x ner 100 - -m1-
Fecal Coliform: MPN Index per 100 ml
_, OTHER ANALYSES,
THESE RESULTS INDICATE THAT THE WATER SAMPLE. WAS '(WAS NOT) (NOT APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING. 0 NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Albert H. Padovani, M.T. ASCP), Director
LEGEND
IDS = Recommend Disinfect-
ing Water Source
< • leas than
TNTC a Too Numerous Too
Re: Property of Nancy Godsen, Administratrix; Estate of Lucille rodGPn
Located at Watson Way
(T) 29 Section - Block 3 Lot
Subdivision of Section One - .Lake Oscawana Acres
Subdv. Lot # L7 Filed Map # 367 A _Date 1/8051
Gentlemen:
This letter is to authorize. Joel Greenberg
a duly licensed professional engineer. or registered architect Xg
.(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 necOssary 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, �� p gR is Health Law; and the Putnam County Sani-
tary Code.
Countersigned
P.E., R.A.,
ELeNCE GR �
� 2
° Very truly yours,
Signed EE +mom Wc.i (4,5. G045e4W
6 Owner of Property
NE
56
Muscoot Nrth., RFD #2, Bx 488
Address
Mahopac, NY 10541
914 628 -6613
Telephone
Box 33
Address
Old Chatham, NY 12136
Town
914 628 -3100
Telephone
Re.
Property of Nancy Godsen, Administratrix; Estate of Lucille S.. Godsen
Located at Watson Way
(T) 29 Section Block 3 Lot 2
Subdivision of Section One - Lake Oscawana Acres
Subdv. Lot- Filed Map # 367 A Date 1./8/51
Gentlemen:
This letter is to authorize Joel Greenberg
a duly licensed professional engineer or registered architect XX
(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- regu.lations as promulagated 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 or systems in conformity with the provisions of Article 145 or.
147, Education Law is Health Law, and the Putnam County Sani-
Sfk p 41%
tary Code. �R6NCE GRF yid
4V ��� I tiv
° -4 Very truly yours,
na,,, .�Zo- sl�vu% �4d wt e }v'v'i x
Signed G's+b,4 4 LvciU S. Gods
Counter signed •
Owner of Property
P.E. , R.A. , # / IX056
Muscoot Nrth., RFD #2, Bx 488
Address
Mahopac, NY 10541
914 628 -6613
Telephone
Box 33
Address
Old Chatham., NY 12136
Town
914 628 -3100
Telephone
,I
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-Date 1/13/86
Re: Property of Joe Cardinale
Located at Watson Way
(T) 29 Section --- Block 3 Lots 1 & 2
Subdivision of Lake Oscswana Acres
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize J061'L. Greenberg
a duly licensed professional engineer - - or registered architect xxx
(Indica-t-e7—
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
connection with this matter and to supervise the construction of said
"-System or systems inconformity wi th the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
signed
Countersigned: Owner of Property
P.E. , R.A. # 11056 Oscawana Lake Road,BX 387A
Address
Muscoot.North,RFb#@ BX 488
Address
Mahn P;4(-'My insAi
628-6613
Telephone
Putnam Valley,NY 10579
Town
528-1505/528-9109
Telephone
_._ ___.._............ ....:..._._,::.�.._ :.:. ��, �. a- ,.,:F;[s;:::;.�sv�.- ..::..:,.f hi-. ..:4..,r�.•Fr�"4'.t:.n�e+e.•+.r �.'"'. ?,"T,ty,y. ' ray.. d;"'?' �Y" 3�$'..'YS.?'c-;.,+`,tl'bt..aAtr �°.b. r.:�+.�a� 'f:"�'r�,�'s�.•
� y
...^..ii•:±�_.:_,,,F- •:x.:,.�,. (•;,,,.""�. s -. s.17.u+o:- s-�..+�i +". _,.'.€^.'x+.d'x' 0.4 sks'."^"'.'°[* '.- 3'cS`l�t.f'y2t�"�,- �r,,,;ar
+°'- "..•:.c_ .
PU-rNAM CouarY DEPARlmERr OF HEALTH - DIVISION OF ENVIRONMEwAL HEALTH SERVICES
TNDTVTnriAT. WATER snPPT.Y SUBSURFACE. RT.M w.. nrcwzcnT. cven7VMC
FIF,U INSPECTION REPORT
.�..zv � • � al`s -,.� �,� �-
Mane o-L-- Owner) (Street Location) +
INITIAL SIrCE INSPECTION YES I NO
Wetlands on /or proximate to property ...........
Property 11hes or corners found.. . .. .
Can estimate house location . .......................
rWill drive<nray need cut ............................
Must trees be removed - note these.................
Deep holes representative of entire SDS area......
Additional deep holes needed ....................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
Access to p:ronosed well location for drillin ..
D.H. 1 Lot ^ D.H. 2 Lot
Depth to G.W. Depth to G.W.
Depth to rack Depth to rock
Soil Descri tion
0 ft.
3 ft.
6 ft.
9 ft.-
~ ~12 ft
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
boll
r-
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
Soil Description
0 ft.
3 ft.
6 ft.
• •9 ft.
12 ft.
Util'Z: — —
.
FINAL SITE INSPECTION INSP.BY:
YES
NO
CCMMERrS
House SSDS located per approved plan.............
Length of trench_ measured
Width of trench average
Slope of tile: line and trench acceptable.........
'
Roan allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.. ......
.line �
,.
10 ft. maintained fran property and
20 ft. from house..
Distance well to SSDS. (ft.) ......... a ........
Ur
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................,
15 ft. of peripheral soil horizontally
fromtrench....... .........................
Boxesproperly set....... . ............. ......
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
I
1
'does lot drainage. appear OK in area of SDS.......
T7.1T T /'T1T TAV+ /'1Cs [-TfT10 T r'Y—L"YfIT DT -m
-
v`
s
.a P
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE 140.
Owner V.: Godsen Address Box 33, Old Chatham, NY 12136
TM
Located at (Street) Watson Wa . 29 Block 3 Lot 'I
�. ca a nearest cross s ree
Municipality_':_Town `of` Putnam: Valley Watershed Hudson River.
....:..SOIL PERCOLATION TEST DATA REQUIRED TO BE 'SUBMITTED WITHfAPPLICATIONS
...... .
hole
Number, CLOCK-TIME
PERCOLATION
PERCOLATION
N to " "'
Start -Stop
apse
Time
Min.
Depth to Water
From. Ground Surface
Start Stop
Inches Inches
Water Le ve
. in .Inches -.....
Drop in
.Inches.
Soil Rate
nn. /in drop
#1 ..1.,.8.c.0.0.= 8::3.3 -`.-
33
- 16 19
3
33 3 =11
8:.:..34- 9 ::0,7..
33 :.
.16 19
3
33/3 =11
33
16 19.
3...
33/3 =11
4_9.',:.4 10.::15..:
. 33 .
16 19
3 :.:. ........33/3
=11
#2..1::.8.,0.5- .8ft.3$:'t.':
` 33 .
16 19
3.'
33/3_,11
2 8'°39- 9:•1 -2
33
16 19
3`
33%3 -11
3.9:13 -9:46
33
16 .19
3
33/3. =11
2Q...
.:33 :.
:1.6 19
3.
33%3 =11
2
,..
Notes; 1). Tuts to.be repeated at same depth until a roximately 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.
84„
IA]DICATE IMTEL AT WHICH GROUND WATER IS ENCOUNTERED 4 Ft.
INDICATE =L'`T0 WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4 °.Fto
TESTS.K-�DE BY Joel. Greenberg. Date May ll: 1983
- - - D SIGN
Soil Rate :Used 1 x�/1 "Drop: S.De Usable Area'Y?rovided TO sF
Noy of Bedrooms . >' 3 - -Septic Tank Capacity 1 000' E'D` a Pre -cast Conc.
Absorption .Area Prov de By 400 L. F.x24" * R� "�fa enc . `r
Mane. Joel Gr6enbi--rcf 3! gnat urej=9ftfill
Address-�-Muscaot North, RFD #2, Box 488 S
Mahopac, NY 10541. 'N
THIS SPACE FOR USE BY HEALTH DEPARVENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
Date
. b
O
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY. - OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN I11TA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner `N...' 'Godsen Address Box 33, Old Chatham, NY`
TM
Locate Si leck Blvd . 29 Block 3 Lot 2
Indicate neare` stcross s ree
Municipality.:.: ::TQwn 'of Putnam . Valley Watershed Hudson River:
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH,APPLICATIONS
4_q ::'4.2 -10 _15 _
33
16
19
3
- 33/3 =11
hole
Number •..:.. _CLOCK TIME
PERCOLATION
- ..
PERCOLATION
No.....:, ..........;.._.:.:: : :.._:::"
Start -Stop
apse
Time ..
Min.
aepth to Water
From Ground Surface
Start Stop
Inches Inches
Water LeveT
. in . Inches
Drop -in
Inches
........ Soil Rate
Min. /in drop
•
#1 ..1::8.:- 00= 8.:.33.:
'33
.16
19
.3
33/3 =11
2...8.:.34.= .9..:'O:7..
33
16
19
3
33/3 =11
.3..9::..0.8 "9- :.41.:..,
33
.�,
16
.19
.3. ...
3313 =11
4_q ::'4.2 -10 _15 _
33
16
19
3
- 33/3 =11
5-
#2 .1::181::,05 =, .8:!:38:1,3;; :
' 33 .
16
19
1:
33%3 =11'
2 8.39 -9. ,12
33
_..i6
19..
3
3:.9..:13 -9 :46
33
16
19
3
- 33/.3. =11
_11 20 ..:
.33:
16
19
3
33/3 =11
1.
•
2
3
_
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obte,ined a,t each percolation test hole. All data to be submitted
for review.
.'2) Depth measurements to be made from top of hole.
N. J
TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES.
DEPTH HOLE: NO. DTH HOLE NO. HOLE NO.
-G.L. Zop Soil: .
6" Sand..Small Stones
& :Some :pla
y
12"
m1i
72"
72
8411 "
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 4 Ft.
IIITDICATE T 'L TO WITCH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4 .Ft,
TESTS MADE BY Joel Greenberg Date May llj 1983
-DE iGN _ _...
Soil Rate Used Drop: S.D. Usable Area provided 5'rpp SF
No: of Bedrooms - `Y =3 Septic'. Tank Capacity 1 000* Gals , Type Pre- ast Conc,
Absorption Area Provided By 400 L. F. x24" * r
Flame Joel Greenberg Signature.
Address_ - -, Muscoot North, 'RFD #2, Box 488 S L
Mahopac, NY 10541
THIS SPACE FOR 'USE BY-'HEALTH DEPARTMENT ONLY: 4� moo'.
F oPr NEyr
Soil Rate- Approved Sq.- Ft/Cal. Checked by
0