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02687
� ; PUTNAM COUr
Division -of Enwr`onmo
CONSTRUCTION: PERMIT .FOR. SEWAGE DISPOSAL
,, Located•, t 5 — j - ��,
'- Subdwisi�
+:•Owners: '.:. - h :` t ry, ,
7
Separate Sewerage System
to., of
`5 Faro be .constructed bye tai
_ r 3
' .-Wafer-Supplyv Public ..Supply`From ,"
' Privafe Supply to be drilled by
V ,w 1-
„y
Address
:Other Requirements � v
ed as stioN
an
WIII bejocatea as snown on the approveo plan anatnat saia wen wm oe..
K
County'D partment of •;Health.;
Date S 191191
Address ' 1
APPROVED FOR CONSTRUCTION This approval expires one year{
t , ° :revocable for cause or may be amended or modified when con eredFn
�z requires: a' n ,germIt; Approved for disposal of domestic san y
T Date y �� >6
OF HEALTH s
armel ` %N Y 110512
:v
4,71 + ;_
ti Town or,Y illage
ct�on� J,
r C
d
wv a'FP`Cty$ ?M y. ,1 y
ital Habitable Space Square +Feet;:
add 1lneal Meet XQ width, trench
ldress 7
t Y �
imposed ;system(s),jl) Ahet7the;separate;'3ewage .dispos8l. s stem
ordance with thestandards, rules _an_ -regu a ionso e u name
tionCompliance 'satisfactory to the Comniissionerof Health will.
3rsuccessors heirs or assigns by :th4.b
6184, that '3afdYbuilder will
eriod .of -two (2) yearsimmediately foliowing the date 'of Elie fssu
m organ ?repairsthereto 2) thatahe tlrilled,well'descrlbetl''above:.
the 'st ards rules and r'egu aTfrons of ; the Putnam.
NO
T
P E. R Ai
,�•
unless construction of the building,has "been u dertaken.and Is
t
i " of Health Any change or-alteration of,'consOuction,,_
ti �. 4.• °F �a :Title � i.s ,+ +
.1.
FITNAM-C.OUN'Ty DEPARTMENT Or HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of John M i e l e
Located at:
Section Block Lot
' a
Gentlemen
i
This letter is to authorize George A.;Haughney
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
Lepartment of Health, and to sign all necessary papers on my behalf in
connection with this matter anci.to.supervise the construction 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 'Sara
Lary Code: ,
tr►rp�r►r��� Very truly yours.
d t N f Ji,
�!,� Signed -
� = Owner of Property
. .
Countersigned:
_ e- ,
Q -Addoss
P.E., R.A." #
Route 52 Telephopfer
_ Address
Carmel New York 1051.2
(914) 225_9353
_. Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HL'ALTH SERVICES
CARR L; --N 'Y':
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILETr NO.
Owner re s Mau) 1 :r.
Located at ( StreetUjVoc�,e-4 Sec. Bl k Lot
n e ne r s cross s Tee
Municipality is Watershed J. l
TION TEST IWTA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TINE
PERCOLATION
PERCOLATION
Run
apse
p
o Water
Water Level
No.
Time
From Ground Surface
in Inches
Soil Rate
.Start -Stop
Min.
Start
Stop
Drop in
Kin. /in drop
Inches
Inches
Inches
111 op -
- A
31.4z -
1 u
2
4 -Z 0-7- Z. 3-�r c;� 9 i � -2 e
1
3
4
Notes: .1) Tests to-be repeated at same depth until a roximately equ41 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF' SOTLZ Is1,1CO11T,':[ERFD IN `.T'E'ST HOLES
DEPTH HOLE 'NO. HOLE NO. HOLE NO.
G.L.
1211
18'1
2411
3011
3611
4 211
4811
5411
60"
66'1
7211
an
*
INDICATE LEVEL AT 1�THICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO C W TER LEVEL RISES A`-'TER BEING ENCOUNTERED
TESTS .MADE BY Date
ft
DESIGN
-.Soil... Rate:: Used ?j-- SOM�.n/l "Drop.
:.:.._:,....
S.D. `Usable Area
Provided
C->OD6
No: of 'Bedrooms Septic Tank Capacit)j?50
' Gals
1511 t1►1
' _
s�.w'F
Absorptio Area P ovided ByL. F. x24"
� ,�`
t
Vic.
c
AT
�
�
•• �o�G�
Sip-nature
Address SEAL
THIS SPACE FOR USE BY F..EAL`.Pti DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal.
Checked by
Pate
1 A /f�'(� t., Cl ,� _ t�•T . � � � j .,< h t� ��� � �a�i +5 �tk � >'l Y�)r
PUTNAM COUNTY DEPARTMENT
5
+ '� , +� w.� Division ot;Environmenial Healih „Services, �.G
T { -w ;`a •,
CERTIFKATE: OF .CONSTRUCTION COMPLIANCE'F.OR` SEWAGE DISPOSE
4 y
Located at Tai
y L01
Owner
t
Separat Sewerage System bullt?by w Ad
a')
Coniliting of I y5eptic ,T,•ank and
'Other requirements °
Wa lic ter SuPPIy y.PubSuPPIy From '
S,Y:
Ne
BSS
7
K
� f k
�ALTH •
Y 10512
M s G
-
�/ 4
J F y Block v
C1J I
l Job c
c
i'.
I certify- that.the'system(s) as listedibrvin4A a above'premiseSwere'-constructed essenti a
attached], 'and 'in,accordancewith the standardriruiesand r'egulationi plansf`�ted ` th
t
Date � � '�� � � � '`Certified�by
Address
Any.,person occupying rpremises served by the above`system(s) shallipromptly {take` d
such a
condit'Ions resulting from "such iutage Approval of''titheyseparate ewerage system sha "II' b
avallable and the approval, of the private water supply shall Zb come null and % "voitl wl eri'i
subject to modi[ication ,oi�, change .when in the Judgment `ot the Com s ner f Heal
bate
M
Il�itt®
tnam County, Department -of Health
i
License No. �u
as may ben cessary to secure the correction of any unsanifaiy
me`null,dnd void as soon as a public sanitary sewar� becomes k `':
1bi'c water sup` becomes available 'Such approvals are
such revocati ' ,modification o-r ;'change Is necessary -
Title' a {
i t
Private Supply-,,: brilled 8y
_
ddress
' .. '.. tiw .> '' ; S � ,�.. T' { t i 7x. �,. y � "t �.
f r ^_ S � i � t• v �
Building, Type No of Bedrooms-
Date Permit Issued
N'
• Has Erosion Cont►ol eeeri' Completed? ` ti
4 Y
r
4
'•.,- ;,� .''., -.'., i;, 4 r r'>> r �' Ra). t ....: ♦ .t w , _..
u ^
I certify- that.the'system(s) as listedibrvin4A a above'premiseSwere'-constructed essenti a
attached], 'and 'in,accordancewith the standardriruiesand r'egulationi plansf`�ted ` th
t
Date � � '�� � � � '`Certified�by
Address
Any.,person occupying rpremises served by the above`system(s) shallipromptly {take` d
such a
condit'Ions resulting from "such iutage Approval of''titheyseparate ewerage system sha "II' b
avallable and the approval, of the private water supply shall Zb come null and % "voitl wl eri'i
subject to modi[ication ,oi�, change .when in the Judgment `ot the Com s ner f Heal
bate
M
Il�itt®
tnam County, Department -of Health
i
License No. �u
as may ben cessary to secure the correction of any unsanifaiy
me`null,dnd void as soon as a public sanitary sewar� becomes k `':
1bi'c water sup` becomes available 'Such approvals are
such revocati ' ,modification o-r ;'change Is necessary -
Title' a {
i t
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SO
.-TOWN OF PUTNAM VALLEY
W-,= DRILLERS LOG AND REPORT
WELL LOCATION '� (�i�.l c .� .. f f ��,� ��� - _ _�- �+ .
4-4 U I
-1, 1 -4-
41;LL OWNER -J 0 N K-)
A( ac-
S G,
name .
address city or t&Wn
WELL DRILLER
&S
IS-/ *I 14L � l �rjYyl'l`�.
name
address city or town 1.
0,% !NG DETAILS
YIELD TEST
WATER LEVEL
SCREEN DETUroc
Leugh: feet
6� 3
Bailed
or
�Measure from
surface
. .
...... Pumped (oHrs.
Stati,-. 30f t
Make: 6 f E
11
'jL-.,z-.ineter: Inches
Yield:/,��GPM
When Bailed
or PumpedVSft,
Length Ft...
Ft.
siLzot e
-L-urld..
ti t,
Diameter In
7F2TH OF WELL Feet
.uep-un v.rom
..'roui 'id 0 '�urfade
50
-uive.cLescrip-cion or rorma-� ion penetrated, such as: peat-4,1*i,`.>/,
silt' sand, gravel, clay,' hardpan, shale, sandstone,
granite, etc. Include siz:a of gravel(diameter and sand
fine, medium, course), color offmaterial ' structure
(Loose, packed, cemented, soft, hard) .(Ex. Oft. to 2,-/ ft,,,""
, 2
fine p acked, yvell.o,,--sai.d-,-,-. -L
i
34 ft gray, granii-LL
at' least two permenant Landmarks'
I; qk t ocozk
'.j
�L)ate dell Completed..., Date of Report
Well Driller ttlllel�-
UG
i
1879 Siit)R
u-1..
V.
FaESUI..TS ®� E�XAFAI�A�1 ®R('
OWNER ' tU
V
CITY„, VILLAGE, TOWN VOR'NAMC -OF SUPPLY
SA LING POINTS t k n:
� tald -� � -�5� p � � y f ' ��" � f7 �.,p� t : � � Y v.=� P k (�%ti •r rt - '1.. 4 I�`r'� ra
�y J�.'��+t•tc p1,r•��•^
rC. � 'f�: t i ;q .�'. RG �•Yf �l
KSKILL�ME®ICAL LABORATORY
and i,d BAi6jd t�Plaza Bldg A, Apt
.,zis r� �� �!�, '� 'a r `sr y, 't d�..re � � • + } ` FJr Q * *Jra.�]� �.�1�
�.d1„ : " i" ✓r _ 2�ti^j•4Y�r ?z� f �•'��� c "'P - F'r' i i` < a i.. }
< DATE CO LECTED '
y� � Y• py �y
1F7 T ER 4'C . k '4• �,/':� F 1 [ .S r Ir '�• I 4 f' �•r
yp u�,c T`(d •-` q �: 7 u:J `i F P ...Fy Yf ',�y 'S`., i
DATE RECEIVED' x :• a "'
'`'','•s"St r 1'�
r4 ,� DATE REPORTED',
BA ERIA -PER ML (Aq� pin (a count at 35 C)
t'
COLiFORM,GROUP (Most pro le 46 /100m1.)
LYL."
=�
D TOTAL.- pwn
`
1
-Less �ia ri a�l�
DETERGENTS - ppm
NITRATES (as N) =:ppm f .
' "IRON, TOTAL- ppm
FLOURIDE (F) - mg. /1.
These results Indicate that the water was y�S , of a eatisfactory sanitary quajity when.the sample was collected.
941
H. PADOVANI, M. T. (ASCP)
iv
S
v Y a'tY T2$
q
0 < •• i
��' q�Y' Y t CA �9r��2c��FFVt ?!yC7G.. #d �@u_ r•1
• y^^ n ..:ix.,:. �.: - .V.r.r� .-+. e.�p"�a.� :..•ar. �..r_ �:•.= �.- : -._r -� . r ,. .n .�nc .+e.- _ - � - - _ _ .nav ia. c. Ci>:.. e• w�re.,�+.•;r..mww•.•"".,i:���,e
0 er or Purchaser of Building nicipa ity
Building Constructed by
Section
Block
l
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 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-
�.�_zz�ces =_o Puha7ra.:,o:unty D•epa-r-•t men l, - o= r-•nst =the failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the sys m.
'Dated this day of 19 Signature
ell
Title
li- corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP.TETION 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