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BOX 22
02643
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02643
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Must Provide P V 18-85 _
P.C.H.D. Permit N— S-0. 2245
�y
CERTIFI TE .OE CONSTRUCTON. COMPLIANCE .Fl3R SEWAGE DISPOSzAL,SYSTEW. -_ _ ; ; :T.. ; 'Putnam Ala l 1
Town or Village
Located at Porters Road To' Map 18 Block 1 Lot 23
Owner /applicant Name Karen & Dennis Sc u jfine --- Subdivision Name - - - - - - - Subdv Lot q - - - -
Mailing Address 62 Laurel Place zip 10594 Date Permit Issued
Thornwood, NY
Separate Sewerage System built by {inward R_ Gragprr Address R11 7, Piji-nam Val 1 eV, NY 10579
Consisting of 1 000 Gallon Septic Tank and 80' Tri�ga l Taxis°
Water Supply: Public Supply From Address
or: x Private Supply Drilled by rd Anderson Address - Putnam V a l l p y, NV 10579
Building Type log Has Erosion Control Been Completed? Yes
Number of Bedrooms three Has Garbage Grinder Been installed? no
Other Requirements R -O -B fill spnt_inn: (600 ±_c r- yds.)-100 x 25' x average depth 61,-,'
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 regulatAons, in accordance with iled plan, and the permit issued by the
Putnam County Department of Health. ,� /
Date May 27, 1986 certified by . 4LZ �'-� P.E. X R.A.
Address
License No. 99906
Any parson occupying premises served by the above system(s) sh*:so—we9e ke such action as may be necessary t0 [eCU►0 the Correction of any unsanitary
conditions resulting from such usage. Approval of the separat4shall e null antl void as soon a[ a pub(': unitary ewer becomes
available and th appro al of the private water supply shall bocoblic water supply becomes available. Such approvals are
sub)ect to mo fatal{ or change when, in the Judgment of tuch revecatio , modifi cation or change Is noce[ury,
Date V By Title
Ag
/ PUTNAM COUNTY DEPARTMENT. --..OF - HEALTH Permit [
QiwsioR. of Environmeptal �Nealill SBi1 ices ;Carmel _N1_Y Y.. 1.(1512...:
z�
_- - d a Q-
,ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM_ ` Putnam Valle
�:'
Town ' or Wiagg
. ocated at Porters. Road Tax neap 18 Block 1. ,'. lot 23
ubdivision - - -- Subd. Lot`# -- Renewal Revision `❑ '
,mer /address Karen & Dennis Sculley, 62 Laurel Place, ThorWOo4��eevY A]p.0��94
wilding Type Log Lot Area 2.189 AcrPA,
lumber of Bedrooms Three Design Flow G /P /D 600 -
operate Sewerage System to consist of 1000 Gal. Septic Tank
'o be constructed by
rater' Supply: Public Supply From
? Private Supply to be drilled by
Fill Section Only
P.C. H. D. Notification Required
and 333'. x 24" wide laterals
Address
Address
ther Requirements R-O -B Fill Section: 3914 sl1 ft x 36" Deep (3 98 cu yds )
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
)ove described will be constructed as shown on the approved amendment there to-and in accordance with the standards, rules and regulations of e Putnam
aunty Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
e. 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
'Lace in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu-
t-e of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
,t�be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu a ons of the Putnam
6 ty Department of Health.
;, ;. April 29, 1985 JW444.4 R.A.
•a 9 7 (16
Address � – License No. 2_
li'cy'L"._k'l ?D FOR CONSTRUCTION: This approval expires one year from the tlate issued unless construction of the building has been undertaken and is
+.o (or rouse or may be amended or modified when considered necessary by the issioner of Health. Any Change or alteration of construction
� � r�; eel permit. Gp�ed for disposal of dom rc d sewag9� a d /or rive y�y�t�.lupply only. �"^�
Yorktown, Medical Laboratory, Inc. LAB
321 Kear Street
Yorktown Heights, N. Y. 10598 Collection Station Used:
Carmel _ Peekskill
(914)245 -3203 Mt. Kisco New City _
Director: Albert H. Padovani M. T. (ASCP)
Date Received:'q- 5- ,.-Rc)
Date Reported: S _M_�ko
c} Collected By:
Referred By:
L �U..��.��t`� � �\\� ) �, J p
Saml a Source: _
l :+ 9,1 TQ \ J'w T
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count per 100 ml TVTC_
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
�- Tota -1 Coliform ner 100 ml
Fecal Coliform per 100 ml
Fecal Streptococcus per 100 ml
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN Index*ner 100 ml
w__._.._ MR. N:... I. n_de.x._.per...1.00�.m1...__._.: _.._.:.: ....... ._:.._.._�... - ....__.___ ._..__..:
OTHER ANALYSES
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS) (WAS NOT) (NOT APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT. THE VIME OF COLLECTION.
P
Albert I#. Padovani, ?4.T.9 ASCP), Director
LEGEND
RDS = Recommend Disinfect-
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
i
Owner or urchaser o Building SecQ tion
Owners 1
__:,. -- :•Btz�-d-�:�ig� Cars- -�i�ti:t•ee�I:.�_���._ _F. -,:�: .� -,.� ..:_:..:` - Bl;os�.s. r :_: :,_- ;x�- :- u;._.-;..,�� -- :.: __. _�__�_ _. _< _..... -.- - .._..�
Porters Road 23
Location - Street Lot
Putnam Valley
Municipality
Log
Building Type
Subdivision Name
Subdv. Lot ##
GUARANTEE 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 shows 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 guarantee to the owner, his success-
ors, 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 fallowing 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 determin-
ation of the Director of the Division of Environmental Health Services
..,,_.. M.z�'fl- the.��utnam• Co�rrt3% -_ Department :of = I�ar�..th, as.. to::- u�e'ther -�: or..: riot: the ::fai.1 --� .. -. .: .
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this 16th day of May 19 86 Signature
Title Owner
Karen & Dennis Scull
Corporation Name if corp.)
62 Laurel Place, Thornwood, NY 10594
Address
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUI`R.ED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
Karen & Dennis Scull TM .18
Owner or Purchaser of Building Section
Owners
Building : Constructed:
Porters Road 23
Location - Street Lot
Putnam Valley
Municipality
Log
Building Type
Subdivision Name
Subdv. Lot #
GUARANTEE 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 guarantee to the owner, his success-
ors, 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 determin-
ation of the Director of the Division of Environmental Health Services
of , the�Purt:1441L _.C2untY _D3elZ x .merit. of. HeaLth as...:to wfiear..er, or,.no.t::th.q_..fai:1-
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this 16th day of May 19 86 Signature J4
Title Installer
Howard Gragert
Corporation Name if Corp.
RD #2, Putnam Valley, NY 10579
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
vwi6%%b Wwrwarkr.1 ivm nLr-VMI
3/7J
ruimAm utrurdsi w;.r^ntmcrvv wr nc^6ji
Division of trivirontneAtal Health Sefvicn
COUNTY OFFICE BUILDING - CARMEL, NEW YoRi
This report is to be completed by welfV• ;Iler 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_ Y :z
-SVORUTED WITHIN, 39-DA S OF WELL COMPLETION
OWNER
APDAISS n f
LOCATION S
(No Sir (Lot Number)
°PUTNAM COuRrY DEPARTMw OF HEALTH - DIVISION OF ENVIROmIENTAL HEALTH SERVICES
FIELD INSPECTION REPORT _�' -
- - 1
DATE - - - -
.
'5 -f- INSP. BY:
( of Owner) Street Location)
INITIAL SITE INSPECTION /'o 95- YES NO COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location.......... ...........
Will driveway 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 ............................
D.H. 1 Lot
Depth to G. W.
Depth to rock
Soil DescriAti(
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.l
f U GL
D.H. - Deep Hole
G.W.- Groundwater
D.H. 2 Lot D.H. 3 Lot
Depth to G. W. Depth to G. W.
Depth to rock Depth to rock
5011
0 ft.
3 ft.
6 ft.
9 ft.
Soil Descri tion
0 ft.
3 -ft.
6 ft.
9 ft.
12 ft.
... , r,
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
CCMM ENTS
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. fran watercourse ..............
!,
Natural soil not stripped or SDS area
unnecessarly
graded .........................,..
10 ft. maintained fran property line and
20 ft, fran house.. .,,,
...
Distance well to SSDS.(ft.) ..... . .P... .........
' J
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench.. ............/
L5 ft. of peripheral soil horizontally
fran trench ..... ...............................
3oxes properly set.. . .... ...................
:ould surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
bes lot drainage appear OK in area of SDS.......
�s
/
,
?INAL GRADNG OF SITE ACCEPTABLE..
.. .`� PUTNAM COUNTY DEPARTMENT OF HEALTH
i
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date March 11, 1985
Re: Property of Karen & Dennis Scully
Located at Porters Road
(T) Putnam Valley Section 18 Block 1 Lot 23
Subdivision of
Subdv. Lot # Filed Map #
Gentlemen:
This letter is to authorize John H. Prentiss
Date
a duly licensed :professional engineer X 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
connection with this matter and to supervise the construction of said
system..or.,- systems. in., conformity wi: ter the- proves lons_.-o_£._Art- i.cle:.145
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
`.
ery truly yours,
igned xln41wf )d.�
Owner of Property
62 Laurel Place
Address
Thornwood, NY 10594
Address JOHN'H. PRENTISS, A.E. Town
RD9 rAIR ST 914-878-6171 ° 7
CARPAL, NEW YORK 10512 r- j�„ i 914 - 7 6 9 - 6 0 5 7
Telephone
M ny {9
Telephone
PUTNAM, r,.OUN T Y
®EPA.. HEALTH
d
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES.
__..._..,. _ : , ,...�.,. _ �-.:._.____.-.:... �... �__......._.. ..._..__..._...__.__
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512•
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM ... FILE NO.
Owner. (Caren*
q r Cn .d GP., j fv aau
14 Address-
.Located-at
(Street )i C6 • P' ` " j8 Block.. j Lot
((indica e neareKt cross street)
Municipality Pu'4 !y w, V& ( Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION.
apse - Depth-to Water "Water Level _
No. Time From Ground Surface in Inches Soil Rate..
Start -Sto p' Min. Start' Sto p ..Drop. in
- Min. /in drop
Inches Inches Inches
11033 lo;) 2-1 24 l7 3
2 1011 27
3I11, 1IS7 39
4 I S7 �13G 3 9 1�4- 27 3
,.5
h�
3
4
5 MAYA
PU7N/ -M COUNTY
POL OF HEALTH
Notes: 1) Te'E�ts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. App data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO
_DESCRIPTION .,OF__SOIIZ.
DEPTH HOLE NO..
GeL.
6"
121
24,11 ..
30
36"
42 "_
4811
54"
60"
66"
72"
78"
8)+
SUBMITTED -WITH APPLICATION
OUNTERED IN TEST HOLES
HOLE NO..
INDICATE LEVEL.: -AT' ;WHICH _GROUND .WATER. IS .ENCOUNTERED N)a ,o
'INDICATE `LEML 'TO. WHICH -MATER- LEVEL `RISES AFTER `BEING- ENGOUNTERED 1,
TESTS MADE BY s4 Date
DESIGN
Soil Rate Used Il-�_Min4/1 "Drop: S.D. Usable Area Provided Poa�
No. of Bedrooms�T1 ee�Se pti c Tank Capacity. Gals. Type
Absorption Area Provided By_L.F.x2�+" '— width trenc
R -O -� 611 SPGz'ie . u 34'DM (318 d 9) sio 4
Name igna ure
Address
1'w
THIS
SPACE FOR USE
BY HEALTH DEPARTMENT
ONLY:
Soil
Rate Approved
Sq. Ft /Cal.
Checked by
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A
J:01
/t
1pQ,� r
/ ,(rye • .
/1 ,1/0 t7 _c.na Coc ty Loaar:n.nt, of Boa.th
LivisI if .Ira tal Heaith Services
ADyrMg o ad for onformatioe with
i Est livable ea am Regulations of the r
t Co y salt pepprtment -\�� /- f
ignature a T tle Date -i--
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t 1,
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Structure located from survey by Surveyor notedi baio4,9
Well IaCaiesi by: Surveyors sujvo y•
Weil drititirs roporl
Tonk, ooxea; p:ts, galleries O iuterals Inyated by`�antrgetnrs
�np loser:,
-
�Fiala inspect tan by: Ftenifh dept �( daiio-c�..._._.__.._., 7 -04-
>rnyrrta,r Q4$
NOTES: I
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loo X2 P> XAV6194AG PIS CIH oF.lai!zi•
D I M E NSlk_Nc_
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A - K _. _8 - K
SANITARY SYSy�E DESIGN *"A�' BUlL�;'
�RFATKiN Street: �p� t�r_ �_�OA(� •_ _ _ _
Town: -eJTt Ah/1i.(Zc.unty 3j.tq%>H
S08D1VIS10
Map:
Block•, LOT
Builder; ^_
Surveyor: A G _ T-
�._ �... Ja _ a
Drawn: D D� Date:r>�Z7_8(o Scale:lu_ 2Z 5
Dw9. -
J0HN NI PRfNT.ISS PE;
CONSULTING ENGINEER 1
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