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02683
PUTIVAM tCOU
..�
Division of Enviionn
`GONST_RUCTION !PERMIT,_FOR SEWAGE' bISPOSA'1
Located _at
ym$ySubd� vision o - �� r`.
gwner ^7OtaGi._o�S �. 1►C"l.S_ OtJ4
�ai3wldmg' °Type
h 4— ber': of Bedrooms
r k -�
1 SeparaWsewerage System to consist of
1- M
-To be constructed
t Publ c Suply p From
Water Supply
r'Prrvate Supply ,to be drilled by.
Qy L
t � `Otherr Requirements
� � 1
,dC a.uun�y �npnnrngnt ur 71 na1u1
e, Date
Address
'nAPPRO•VED FOR' CONSTRUCTION This approval
devocab'le for cause or may be amended or.',modified;
crequires.a n permit :'Approved for disposal of_F
!Date e
vIENT z'OF, HEAL`T, IN
ices , -armei, -N Y,. 10542
x vTNAr� VALbFq
a
� � s Town or-'Village
6ee4ren 11- _ . Block
Job d
z
Address yl �1 �'Mo�Q1S ST O OJ -i.�E R5
` r Q�/Eif� 1 Soo
,'�TOtal Hab� fabler Space - � _ Square ;Feet
lineal feat, X ;width drerich
' AAddress �o
VpL a� of - Al Y
t,
t
fr'the proposed system(s); 1)' that the ,separate, sewage disposal iysiem
inn accordance witW66 standards; rulei, and ,raga a_ ions o e u nam
onstruction 4Compliance ';at�sfactory ,td the Commissloner of Health'will
N`a ,,,sneyrrstihem s, sourcrcaesyso � ►re5 pl(ah2ier) is rYs)eoarsaismsigirnesdfbiay t etlhye , fboulloildweivn'g .t hthatedmaitde•' boufi,tldheer ;iwssuill.,', ir wo !
gtheipeiod on t
'
thereto 2) that the dnlled',;well described above -'
rdance with' a stand s rules and legu a ons +of the Putnam
License
Y
issued ;unless construction of the, budding has';been undertaken and is';
e Comm�sswner rof Health t Any change 'or. alteratlon',of.,construction '
�ap a e; water supply only "t " .
_. . a. wl�. �'- w�..•". �a:,-.' a; �;...- �akr,: t-+ x*Y,,�4Y.- :°:'"k!t-�k7'.. -.. 'c�% °'-� r � . ;. �'f - I
FUT \'AtI
COUNTY DE ?A?T: N1 OF '" LTH
-DIVISI'ON` OF`--tL VI O\ C`%1L'�iF. ,Tr[ ��?��ICLS - .�, , - ,.r�a•�,:.a Ky. .r.
DESI.GN DATA SHEET = SEPARATE
S E DISPOSAL SY'STc, . FILE NO.
0�oner 0,yGLAS i`i. NEL' oC� Address, tt'1 MolZ&iS �otyi��.�'S ;
_ )(.MAP
Located at .(street). �5uoSiFt
i-�ti L* iiZPA $w ._ S'7 Block 3 Lot
(Indicate nearest. cross street)
hfunic ty ISO T O M �%L�:>r y GC Ucr p
pal
,;atershe'cl`6.,� o.
SOIL" PERCOLATION TEST DATA ' REOUhRED `TO.; BE SUE -TED. WITH A"PPL`IC.ATION
Hole..
Nu mber CLOC K TIME
PE.IRCOL_ATIO \T PEP,COL =ITION
Run ElaQSe
Dep �_: to �rate:r rya ter Level
No. Tine•
Frog:: Ground Surr`ce in Inches Soil Rate--
Start' Stop Min.
Start Stop Drop -in Min/in.drop
Inches Inc:nes Inches .
IPi l S�s� 9.'11 9-0
icy 8 12. c'
2
Pz 1 ��da q ►z9 29
�c� /y 19'iy.
2.
3 to: vZ to!:3
5•
2. ,.
5
'`'�• '�'
.Notes.
.
1) Pests to be repeated at same depth until .approx'_ - =te1� eq�t.al soil rates are ob-
tained. at each percolation
test hole. All data to be submitted -f'or reviecq.
' nantn ,rc
i
TEST' PIT.,DATA REQUIRED TO PE SUBLMITTED ;'TTH APPLICATION
DESCRIPTION
OP SOILS E'. 'O'UNTERED I`: TEST
HOLES'
�` f
7�rP
�oU�
DEPTH
HOVE NO ....
j ,HOL \0 z-
HOLE;, N0
".
I. —O.P 51
aPSot�.
c C'Ot,_.
. -G.L.
12,
Arc \}.y�ACEi.Ayo
tears
rt ..
8
2.4"
3.0't
Sfohe -,
Q
1�1
F
�o
c
°
ti
�U
0
0
m
Tk
cSURI/rEY of oRDplef-Rj"Y '.
.�RE.oF�.4•EO FOR ;r :
vov X � f. 400AIA407 AMM t5O"
(_s'rrvATAc_ /w
Pviit�R/y1 C'oUNrJ! _
p C �1 (� .tr A C �. • �
ry
v �
0 r
--. /cS1`one
......... c ............ °"'_ - -- gp'jl
c..gnrop.,a: a.tJ kpar•�1 �✓`56� 20 s4/ /05,29' Sfoke � �• �� �
SURVEYED & PREPARED BY ®�®
BUNNEY ASSOCIATES
ENGINEERS & SURVEYORS et •iSm..+- r..<a+trvav�
'a;s r .•+ •, •rccorc•:n:.s -.h7. ti,a :,;1 cr-trirrri.tyn» hrn:on arc valid for r.6e map and ttip.s'n
20 WOODSBRIDGE ROAD vr)y i, said 1114p or cupies ttvar Ur.- impnas•d
KATONAH. NEW YORK 10536 ;uror t "P'•'r+ lry rn.,, 46.. ear. tsr,. ',a! a: fire btifvesur whose signature appears here.m."
,.. ....,.r. ..r• +t!a64••.�: • °na tiu vrc:.- � ,
N. v. S. uc. No. wean SURVEYED AS IN POSSESSION
x•
/.97/
M
•
r�:z
= .ART /� /EO TO J'HE F /f��ST
NF�J" /OrVAL .BANK ;' •
-�y
f
r
�+
r
+
u�
u;
3
FILE NO.
9f•
Y'
i
i.
�A
VC
PUT.NAM
r(V ices, -,-`--QrFne1r,-N Y-. • 10512'
Dlvision ;of 'Eih
j.Cbcafid".
',Separate Sewerage System built .;b 7
pas
_onsisting -o
C Gal., Septic.-- Tank_
-,Othbr P.equirbm"fints' T. f
Mater_Supply Ppl; From
"Mvke Supply' Willed By
drec
Type
,
'.
_4
'Z-Has,,E,r.osion�..-C(iriirdi'� Been O'm0I(teW-..-
1,fcbrfifyl hat the :,L' g1hidrab
c, nd ,
ACC3 riks
pAny person occupying premises serve d y the, 1A
resulting from iuc� h .usage Apbr ,
v I i6
J
modification
qqr. .c, a
e
V� `6
'Width trench,
44
K- 7
Fediborbi,-Z.,", .41_"V_ Date irmW IV ued�-
ally as 'shown o�'the plans of the completed wor,K (copies .oi IT;
which a I re
6a'Ith,
cense.. o6
secure ,the pove ilf� n nspnitary
satl` become null�and void
on e becomes
when aypubl�c water supply becomes availala�je.,`Such Is are
...... . . . . . . . .
A-RTMIEN,!T'r,,OF."�,HIEA,L,,T.,
r(V ices, -,-`--QrFne1r,-N Y-. • 10512'
�'Wfl 'I/AL
Town or- Village viige
Block
Job-
V.— Pip
'Width trench,
44
K- 7
Fediborbi,-Z.,", .41_"V_ Date irmW IV ued�-
ally as 'shown o�'the plans of the completed wor,K (copies .oi IT;
which a I re
6a'Ith,
cense.. o6
secure ,the pove ilf� n nspnitary
satl` become null�and void
on e becomes
when aypubl�c water supply becomes availala�je.,`Such Is are
...... . . . . . . . .
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF' HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK'
be`bo?nplef6d -by Weil-drilleir'dndsubmittdd t6'CduntyH6altK Department-together With ia6dratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
0 AIA14 A/ C k 9- 0 IV
ADDRESS -Z Lt _rA/A Vit)- 42OF I
LOCATION
OF WELL
(No. & Street) (Town) (L61 NUMDSf)
SuIvsC-1 H14k Rod> U'r&A-
PROPOSED
USE OF
WELL
BUSINESS
CzDOMES.TIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
PUBLIC AIR ER OTH
SUPPLY El INDUSTRIAL ❑ CONDITIONING El (Specify)
DRILLING
EQUIPMENT
CASING
DETAILS
M COMPRESSED CABLE OTHER
)
ROTAR Y AIR PERCUSSION ❑ F PERCUSSION ❑ (Specify )
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT RfE SH OE WAS CASING ED?
M-71
I THREADED El WELDED YES El NO YES NO
YIELD
TEST
HOURS o.P.A.
❑ BAILED ❑ PUMPED LN COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
I
cY
DURING YIELD TEST fleet)
Depth of Completed Well
in feet below Land surface;
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (toot)
SLOT SIZE
I
DIAMETER (inches)
IF GRAVEL
I PACKED.
Diameter of well including
gravel pock (Inches):
GRAVEL SIZE (inches)
I
FROM (feet)
I
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
,3 Hoo:
[A R D P/4 Al
SO),IP GRAAILE
MA
A Z 19 _EF
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
6; PM
ffi4
P
DATE WELL COMPLETED
RAIRch i17
DATE OF REPORT
_LR�c JqZj
IWELL DRILLER (Signature) :7
"i
s r
1/�UGLs�s' /'�`- EL 5U•v1 __ oW o c! .^IA ;4LLF
Owner.or Purchaser of building Municipality
•.�.. - .1�'J�R.' �i .: .:yb v 4r'. �.�T v�eC '.t �.. 'R � .. - . :� 1•r.-•�v:'?l+.vaw��sn:.a n� 1 -� � ... � . Ott F ?fir :.15� •.: r.: T.rr
...�u�'GAS .. J"�`--' •` /'•� rsG Sri �+./� ~ .. _ � 7. .. ....
Building. Constructed by "-CFA x P
Location Street Block
e'
Building Type
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am.wholly and completely responsible fors 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 t>ENS andard",
rules and regulations of.the Putnam County. Department of Health, and hereby guaranty
to the owner, his successors,.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.disposat 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 occupant of the building utilizing
the systtn .
The undersigned further agrees.to accept as-conclusive the determination
of the Director of the Division. of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused iby -the .will.ful . or. negligent : a:et of the. occupant, of the building utilizing the
system.
Dated this day of Aoc, l9_7Z Signature
Title
%} n (if corporattion, give name and address)
_ TR.v�"C1Q+��- - '=-- �"- `/�A�UP�S= L[-------------
:'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
e 5•:59 /;3 /O E;r X49.95: _ wl
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. � f "OCT23-1973' .. ,
fOTN M CO Y DEPI DI :.n
t .! -9WE UUON•OF
NVIRONMBITAL HEALTH SERVICE
' \ I to molit -the 'smage
' ' � , ;.O.R t�s plea aadthat t%a system
a9� ° y £, �� •, .. v l R ti.• :IE�pS•'3:Lo, 1M' .G..,G..' ..A• � -�- 5 nlf-:`, . .`\ �lfl� �,• W4
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. � f "OCT23-1973' .. ,
fOTN M CO Y DEPI DI :.n
t .! -9WE UUON•OF
NVIRONMBITAL HEALTH SERVICE
' \ I to molit -the 'smage
' ' � , ;.O.R t�s plea aadthat t%a system
a9� ° y £, �� •, .. v l R ti.• :IE�pS•'3:Lo, 1M' .G..,G..' ..A• � -�- 5 nlf-:`, . .`\ �lfl� �,• W4
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