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02717
CER LIFICATE OF
Owner
.. Separate Sewerage System bu
PUTNAM COUNTY DEPARTMENT OF - HEALTH A
Division of En.virannnntel Heefth Servieft, -Cw�nel, N. 10512 P41 .06
ION COMPLIANCE FOR. SEWAGE DISPOSAL SYSTEM A M.. A
Town or Village
Ta:. Mp
F—o y' Tax Map Lot,# Subd. Lot s0
II -
,Consisting of ✓Gal. optic Tank and
Other requirement !?hVF_Q7PqF T212 elx ✓ r4� 45;�(Snfa_i)
Water Supply: , Supply .From. _7.Private Supply Drilled By
Building Type I I 1 -9 IL w I I —v--z IV r I No. of Bedrooms ;01 Date Permit, issued
Has Erosion Control Been Completed? 4A
I certify that the system(s) as listed-serving the above premises were constructed essentially a shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date a Certified by O.E. R.A.
Address P-P. 0 lr�&4 Ky" se Licen o.
Any person occupying promises served by the above system(s) Shall promptly, take Such action as may be necessary to secure thi,correitlon of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage System Shall become null and void as public unitaryAn"'w'er becomes
available and the approval of the private water supply shall become null and void when a public water ecolmis available. approvals ifie
c or C., modIfIcAtIo
subject to modification or chang§ when, In the judgment of the Commissioner of Health, such revo n,or cruinge Is necessary.
Date— Vh - v41
T Itle
Rev. 9 -81
ic
COINSTRUCTI PERMIT FOR
Subdivision _
PUTNAM COUNTS ®EIPARTI�E� ®� I�HIEAILT][�f t Permit � — X/4 ^
Division of Environmental Health Servfcceses �1_ rmel, N. Y. 10512
SEWAGE DISPOSAL SYSTE <Mj Or "I km yAV V/ y
Town or Village
Subd. lot N Renewal Revision
• Date,Of Previous Approval
Building Type 6 [AM, W7117 Lot Area
-1`, ✓-79 K ^ Fill Section Only ❑
Number of Bedrooms ?2 Design Flow O /P /D. 1 -- P.C. H. D. Notification Required
Separate Sewerage System to consist of 1� -0 Gal. Septic Tank and '� V
To be constructed by —96"2 . " Address
Water Supply: t Public Supply From I
Private Supply to be drilled by
Address
Other Requirements
1 represent that I am wholly and completely responsible for the design and location of the propose
above described will be constructed as shown on the approved amendment there to and in accordant
County Department of Health, and that on completion thereof.a "Certificate of Construction'
be submitted to the Department, and a written guarantee will be furnis ed the owner, hi cc
place in good operating. condition any part of said sewage disposal . sy m during, the `rind c
ante of the approval of.'the Certificate of Construction Compliance of a origin stem or
will be located as shown onUie approved plan and that said well will be instal ed in a rdance w
County epa ment of Health.
Date Signed
Address r
APPROVED FOR CONSTRUCTi6N: This approval expires onXn
rom the dat issued unless
revocable for cause or may be amended or modified when con sieces y b he Commi sio
requires a new permit. Approved disposal of'.domestic s se age, a /o r' at
Date ���" — By
Rev. 9 -81
system(s); 1) that the separate sewage disposal system
with the standards, rules an regulations o e u nam
liancell satisfactory to the Commissioner of Health will
rs, heirs or assigns by the builder, that said builder will
two (2) years immediately following the date of the issu-
y repairs thereto; 2) that the drilled well described above
the standards, rules and regu aeons of the Putnam
v v P.E. R.
License No.
:onstr ct'on of the building has been undertaken and is
it o Health. Any change or alteration of construction
j� PPIy on1Y•. i> p�
Title
I JT I JOEL TRACE
ar_i.rr eff .t� f•_ °RE' `NI'I EC 1 r ♦ afl_. ... +.."R u. . r'CMa.Yr m nom. w.Kf _. - v. f. .r v.<..�.. as r.i..`:.rN r,YUV.r::Y .4!r►� .,. :Y.'...t.
T' T
51 SOMERSTOWN ROAD
OSSINING, NY 10562
OFFICE - (914) 562 -5611
RESIDENCE - (914) 762 -2482
April 14, 1989
Putnam County Department of Health
Div. of Environmental Health Services
110 Old Route Six Center
i
Carmel, New York 10512
Attn: Mr.. Lawrence WerPer
Re: Halpern Residence
PhilipseFBrook Road
Garrison,.New York
(Town of Putnam Valley)
Gentlemen:
Please find enclosed for your review a certificate
of construction compliance, "as- built" drawings,
and guarantee form applicable to the above refer-
enced protect.,.- - -
Thank you for .your attention to the processing of
this application.
ery /txuly/yours ,
Joe.VTrace
JT /ar
i Encls.
�v �v
Owner-or Purc aser of Building
Building Constructed by
l000, . IC - � Y
Location l- Street
Building Type
Municipality
Section
• l
Block
Lot
GUARAITTY OF SEPARATE SEWAGE SYSTEM
I represent that I'am wholly and completely responsible for the
location, worlananship, material, construction and drainage of the s- age
disposal system serving the above described property, and that it.h s been,.
constructed as shown, on the approved plan or approved amendment thereto,
and in accordance with the standards, rules and regulations of the Pu4-nam.
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 se:•ra;e disposal
system, or any repairs made by me to such syst e:i, except where the failure
to operate properly is caused by the vrillful or negligent act of the occu
pant of the building utilizing the systeem.
The undersi.g ned further agrees to accept as conclusive the de-
termination,, of the Director of the Division of._., v. ronme_ntal :- re�1 -th &S- r-
4_'�1 �i" -5:: -8-f .�� tiCi "T-u- Mal-71 /� i r� !- e .o.1 �, n -, i. �.. „�. ..
0 1iV iL li 'L'G p'ar vlllvtlt nedl Li_ °aj `VU Nile 1. GI'* of not
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system.4j26)L[2 L(2kjGI
Dated this /J day of 199 Signature
Title �E e. % 7��
�If corporation, give name
and address)
THREE (3)' COPIES ARE REQUIRED WITH THREE (3) . COPIES OF FINAL PLANS B^.1;VIR E
CERTIFICATE OF COMPLETION ETION WILL BE ISSUED.
GUARANTOR IS, REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Depart ~lent of Health
FINAL SITE MISPFZTION bate
/��,
STREET IL'CATION GWNc R
PERMIT a -- Y � n! Q OR SUEDIVISION LOT Q
kJA
IV
V.
VI.
a. SDS area located as approved plans
b. Fill section - Date of placement
2:1 barrier. I= W= AVG_DPTH
c. Natural soil not str imed
d. Stone, brush, etc., greater than 15' fran SDS are=__
e. 100 ft. fran water course /wetlands.
r. SEEPPEE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,250
b. Septic tank ins' alled level
i
c. 10' minimuu fray foundataon
d. No 90° bends, cleanout within 10 ft. of 45° bend I�
e. DISTRIBUTION BOX
1. All outlets at same elevation - water test
I
2. Protected below frest I
I
3. Minim= 2 ft. oric nal soil between box and trenches
f. J=ION.BOX - 2E2o---ly set
g. TUN=
1. I,zh re?iired - b Leh `h installed L' °
I
2. Distance_ to watercourse ft. I (
I
3. Installed according to plan
I
I
4. Distance c_nt =r to center
I
5. Slorz of trench acceptable 1/16 - 1/32 "/foot.
�I
I
6. 10 feat fran Drcper`v line - 20 fEet - foun- lotions
7. Demth of trench < 30 inches fran surface
8. Roam al.lcwzi for ex mansion,- 50%
I I
9. Size of gravel 3/4 - 1l" ci,= ne+-=r
I I
I
10. Deoth of Gravel. In trench 12" mi nimtrn
I
111.-Pipe ends capped
I i
h. POMP OR DOSS. SYSTEMS
_
2. Overflow tank
3. Alarm, visua? /audio
I
'
4. Pump easi? y accessible manhole to trade
5. First box baffled
I I
6. Cvc1e witznessed by H=. =i th Den�nent
estimated flaw per c_ ,7cle
I I I
HOUSE
a. House located Der approved plans.
I
b. Number of bedrooms I
I
a. We-1-1 located as per approved plans
b. Distance from SDS area ma. -sured ft.
-
c. Casing 18" above grade_
T I
d. Surface drainage around well acceptable. (
I
OVER LL WORFZ -%-g -1P
a_ Bcxes Droperly arcute'3
I
b. All pinees partially ba6cilled
c. All pipes flush with inside of box
I
d. B3ckfill material contains stones < 4" in diany--ter
e. Curtain drain installed according to plan
f. Car`ain drain cutfall protected & dir.to exist_watercours
g. Footinq drains discharge away from SDS area
I
h. Surface water Drotection adeouate
i. erosion c--nzro Drovided on sloces greater than 15$_
2
JOEL TRACE ® ARCHITECT
51 Somerstown Rai., Ossining, NY 10562 -
._....._ o6258i i nesiaerioe (yi4j 762.2482 _
June 3, 1988
Putnam County Department of Health.
Div. of Environmental Health Services
Carmel, New York 10512
RE: Halper Residence
Philipse Brook Road
1
Town of Putnam Valley, NY
Gentlemen:
Please find enclosed for your review drawings and forms
applicable to a replacemnt S.S <D.S. for the above ref-
erenced residence.
Thank you for your attention to the processing of this
application.
Ve trul you s,
.. Joe k � Tr e
JT /ar
Encls.
,her �� i I ��`��y4` Y -' Addreee r✓�` �•`�,
Located at ('$ti►eet) Sea. Block Lot
� 1
`Hole
IAitilwi�w "- .. ALA .
1
CLOCK MME _
Depth to Water f Water Level 1
t. Elapse , From' Ground Surface' in 'Inches /.
1
Time t Start i s to 1 Drop 1
Naw�! r Qt ^w w4,+ lr"#%%AM 1 T. ooh'am iw T'A00%nw
Soil -Rate
i r 14 ,n _, Av*%,n
irk` ,.. .. _. •
., i2 i2
1 f ( 1� 1 t �i�l� 1 , I �I � •
1 1 1 1 1 1 1 1 r
6.71'I �.. .. .:.III 5
pil
eF
_ 1
,;,,
f 2 1 t 1.. 1 T ► 1 +
\ t
f
.3
1 1 t t .1 1. :, , . •,,
Notes s .
1:) Testa 'to be repeated 'at.' same d "`th until. a
ep approximately equal soil rates, are
oDtaiaed at each percolatipn teat mole. ..All data to be submitted for,reviex. ?'
2) Depth measurements to be made from top of. bole. ;,1
PUTNAM COUNTY:DEPARTMENT O
OF HEALTH -"
AIV�S: qN Q ,. Y R
R TAL HTH
e✓OVNTY' O
O/g'TCE B I
IN CA ,
E�IO DATA • 311; 1 1 - SEPARATE SF�M SY M FILE NO. -
- -- _
Located at ('$ti►eet) Sea. Block Lot
� 1
`Hole
IAitilwi�w "- .. ALA .
1
CLOCK MME _
Depth to Water f Water Level 1
t. Elapse , From' Ground Surface' in 'Inches /.
1
Time t Start i s to 1 Drop 1
Naw�! r Qt ^w w4,+ lr"#%%AM 1 T. ooh'am iw T'A00%nw
Soil -Rate
i r 14 ,n _, Av*%,n
irk` ,.. .. _. •
., i2 i2
1 f ( 1� 1 t �i�l� 1 , I �I � •
1 1 1 1 1 1 1 1 r
6.71'I �.. .. .:.III 5
pil
eF
_ 1
,;,,
f 2 1 t 1.. 1 T ► 1 +
\ t
f
.3
1 1 t t .1 1. :, , . •,,
Notes s .
1:) Testa 'to be repeated 'at.' same d "`th until. a
ep approximately equal soil rates, are
oDtaiaed at each percolatipn teat mole. ..All data to be submitted for,reviex. ?'
2) Depth measurements to be made from top of. bole. ;,1
r
r TMF PIT DATA 1EQUIM TO BE ,S tD APPLICATION"
DESCRIPTIMU:'OP SOILS:, ENCOMERM .r' TEST.
.HOLES
DUN. dbO`• °- w6►o ROLE NO.
��///��pp � �y
w LeOo
LAo
t
r
1200 ,
a
42m
48 fo
\66 /at'
2
.
G
MICATE LEM AT WMCR GROM UM IS EMOUMERED
I1�DICATE LEVEL FOR CR WATER RISES AFTgR ' �iE�►G . EI�CO
ow
. .'b
7d e7 WE BY
e L
DESIGN'
Sail. to Used. ps S.D. Usable
v d
i�o 0 of bedrooms' Septic Tank Capaci
Gals
Hasonty. ..Meta. 1,1
'c R E D
Absorption Afea Provided, byL® F. it 24/0 . 3QI d �t th
Name
SEAL1
-
/L - •
..
/� /�, +yam
j i j��/�
� >I
�o. 009" a
'Pu.�tnam , .Co=ts Health t
;
CO ®A.6 dU to ..AMA oVed - So O ® /Gal P "; . OPb6eitm od
r',
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION..OF ENVIRONMENTAL HEALTH SERVICES
Z.7, Z,
Date
.z:Re: 'Property of
"Located at
T) Section, ,Block Lot
Subdivision of �fT�
.!S
'bd'
u v
lot # Filed Map A Date
,-Ge n t1emen:
J-� T�
This letter is to authorize
engineer licensed professional e ineer or registered architect
"
' jIndicate
I 'for a Construction Pe rmit for a )
separate sewage system, to
'th e-above-noted
property in accordance with the standards,,'rules
o'rrtegula:tions as promulagated by, the Commissioner of the Putnam County-
epar.t
me. t,, of Health, and .'to sign all necessary-papers on my behalf in
."cionnection with this matter and to supervise the construction of said
't e
ys-t em 8 i ji, c-on f o rif Q ---e *',&! e
..4471",'Education Law, the 'Public Health.:.Law, and the Putnam County Sani-.''
Mary Code. R E.L ED
30 I
cF FAT
Very truly yours
Signed
wneV of Prb ert-
-R.A. #
. —le
4. ri e' s s
,f F :li`� I�I� '�l,Y' jL
Address
V�
Town
Telephone
I