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02736
�Y .' 'h, i
° - ' ' '� a � . `` PUTNAM • "GOUN.TY.- DEPARTMENT OF- ';HEAliTH . I
Division :of Envionmenial.Health Services, 'Carmel. 'N K.:'1,0512.' '
i
CEFiiIF[ICA7E,"OF CbNSTfi'i1C7"ION GOMPLW -E FOR ,SEWAGE ,DISPOSAL SYSTEM ley' -T)
VaT
mown o`r. v.illaye
ter- -
Trail of the les Map 9A
j�q�
i
Located ,at t Section Block
Virginia Versland 26
Owner; Lot . Job
separate.5ewerage system buil/t� by Donald Heady ° Address Canopus Hollow '.Road, Putnam Valley
width'trenc
i. .'7 h
Q9 .
Consisting of Gal.- Septic .Tank lineal Feet X 36t)
" - .Other requirements
Domestic --IIse Only
Water Supply 'Public supply From ;
't % ,Private' Supply Drilled By s PuCkey We11 drillers
ti 1. _ ._ . A 1 ,. • .a `hy ;� ...,g ., '
Sprout Brook Road, Peekskill, NY ,0566
Address
Building Type R9YIC�1- No: of Bedrooms Date Pejrti u •
Has Erosion Control Been Completed 'Ygg t ; • �(, , 9 • '
ff bF l9 e
I certify that th'e systems as listed serving the above premises were constructed essenti •
r y O, ally as shown on'the plan' to I or iaa�� of which are
' attached), and -in.- accordance with the standards,` rules and_ regulations plans filed and the permit Issued .by et utn Der�nt of Health.
P4 0
pry t �%
x`F date January 21, 1974 aCerfified :by
4,
Address zl Northr
f'-_%': An' y - person occupying premises served by the above system(s) shall'
'conditions, resulting from such, usage. ' ,Approval of the separate's
i 'available .a' nd the approval- of the. private,', water supply shall_ become
subject'to mod ification,or change when in the = judgmerit of the`
oats �d /�79 ey
Q3
r ° �Y • 2 s �N` �027W
•.
npt'ly take such action as maybe necessary to Td t��Ro�t9�cjiOn of any unsanitary
raga system shall become , hull -and void as soon two nitary .sewer becomes
I and void when a' public water supply, becomes available:.., , Such approvals are
loner of,,rHealth such revocation,. modification or change 'is necessary
ILLS '�'L�ew�/.%fi7 r - Title z` �y7i
w
.. .K-�-,
PEEKSKILL MEDICAL LABORATORY
1879 Crompond Rd. Barclay'P1'az,a Bldg. A; Apt. l
Peekskill, _ New York 10566^ PIs,187 7.
. 40836
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER 1/15/74 :.. .
OWNER DATE RECEIVED
Virginia Versland 1/15/74
CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED
T
1/17/74
SAMPLING POINT
Well
BACTERIA PER ML. (Agar plate count at 350 Q.
3,
COLIFORM GROUP (Most probable No, /100m1.)
less than 202.
HARDNESS, TOTAL - ppm
DETERGENTS. - ppm
NITRATES (as N,) - ppm
IRON,' TOTAL - ppm
FLOURIDE. (F) - mg./l.
These results indicate that the water was ire;
m
I
Virginia Versland
Jens Versland
Building Constructed-by
Trail of the Maples
Location - Street
Ranch
Building Type
Putnam _V
^`- ^ uni c ip ali it
Map 139A
Section
Block
26
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 :Wade 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-
vices of the Putnam County Department of Health as to whether or not the
failure. of: the system. to_ operate :was caused ` b.y:•..the•. willful ..or - •negligent
act of the occupant of the building utilizing the system.
Dated this 18 day of Jan 19 74 Signature 'j7
Q --
Title
(� ( corporat'fon, give name
_��. and 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
r
i WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
j 3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to..be cgrttpleted b .y.welll,driller and 50.1nitied:.LO C¢unty. Heaffh l9epartttie►t4 tege ier wi¢h labarat�r"y pdit'o`f' "' "'
aiialyMs of water sample in icating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT. MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COIiflPLETBON
OWNER
NAME
!
L' 4
ADDRESS
Fz
a l,v,
LOCATION
OF WELL
5' /V I'
(No. 6 Street)
RR 0 0 U-r*# A4
(Town)
A
(Lot Number)
PROPOSED
USE OF
WELL
DOMESTIC
SUPPLY
[] ESTABLISHMENT
❑ INDUSTRIAL
❑ FARM
❑ CONDITIONING
❑ TEST WELL
❑ (specify)
DRILLING
EQUIPMENT
ROTARY
❑ COMPRESSED
AIR PERCUSSION
❑ CABLE
PERCUSSION
❑ OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
j
WEIGHT PER FOOT
® THREADED ❑ WELDED
I E SHOE
YES ❑ NO
Lnj
CASING
YES
TED?
NO
YIELD
TEST
❑ BAILED
HOURS
❑ PUMPED L4 COMPRESSED AIR �
G. P.M.
IS—
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Specify feet)
DURING YIELD TEST feet)
l
Depth of Completed Well
in feet below land surface:
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (inches) FROM (teat) TO (lest)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
T - Aa
l
_........_..
_..._
-di,�i%
I s1 i= c i
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
{
I /
1�
DATE WELL COMPLETED
1
DATE DATE OF REPORT
/2
WELL DRILLER (Signature)
C 1 %J v
OU
PUT
me
f 06
Caw
Other equirements-;,,-,-
:des4ribed will be.c6nstruiited as show o me
p ace-.An good opera ing,,cop I ion any _pari of., sa'Id -sewagb 'd
'County Department of Health.- -
JIN
-.Address 1
`
~
Y.
HD
BlocW
Van
nd o" 'poser d tyitem(�) '1).. that wage dispomf system
a I ca rite se
W there to,an1J1'i!j_,acFordanC'e with the'i hdar SAWariff
lationsof :the, Putnam
if the lisu-
eas Undertakeif and Is
FIELD CHIPECK LIST
Date.:
Ins p. b
Tl\TTTTAT, STTR TTI9P7nTT0N IYes I No I Comments
Property lines ,or corners found.. ..o o . . .
Can estimate house location . . . o 0 0 G o .
Will drive way need cut
Must trees be removed -note these . .
Is deep hole representative of entire SDS area
Additional deep holes needed. . . . . . . .
Sufficient SDS area available considering
driveway cut,.house. location, separation
distances, etc . . . . . . . . . . . . . .
DEEP HOLE DATA
Depth:
Water elevation:
Rock elevation:
Soils description:
-- - Date
FINAL SITE INSPECTION Insp. by;e,>, g&j4z l L _.
House located where shown on approved plan.
S%s located where aprrptrAO ,
Width of trench average 3'
Slope of til line and trench acceptable . . .
Room all.-owed for expansion trenches.
Over 50 ft . from swamp.,-,watercourse
Natl.re _ - ' pP ; ... _
? ,1 soil not.. stri Pd of :.;.ADS
unnecessarily graded. . .
10 Ft. maintained from prop.linl.. and
20 ft. from house . . . . . . . . . .
Separation of trench from house, well
etc. follows plan . . . . . . . . . .
Number of bedrooms checks . . . . . . . . ...
Stones, brush, stumps, rubble, etc. greater
than 15 ft. from nearest trench . . . .
15 Ft. of peripheral soil horizontally from.
trench. . ... . . . . . . . 0 . . u .
Junction boxes prope_-ly set
Could surface run off from driveway,. roads,
ground surface, etc. channel near SDS.�
area. . ... . . . . . . .
Does lot drainage appear O.K. in area of SDS'
I -J -L
FINAL
GRADING
OF
SITE
ACCEPTABLE.
Gentlemen:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date July 99 1972
Re: Property of Virginia Verslamd
Located at frail of the %ples
Section 13ap 139A Block - Lot 26
This letter is to authorize John Se Romeo
a duly licensed professional engineer x or registered architect
(Indicate)
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the Commissioner of the Putnam County
T'% --.. y 4- .n TT_. 7 11_ 1 _ '� '.
Lcpal tUJC;jiU C)1 ne al h.1 and o sign all ueuussary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformityrwith the provisions of Article 145 or
147; Education .Iaw' -the -Public Heal•tl�-Iaw'; , and 'the Putnam.. County. Sani
tary Code.
Countersigned:
P . E . ,. R . A . , # 27$46X.%
t
- 1 Nortbri8ge Road
(Seal)
ress
Peekskill, N.Y,
PE 7 - lo56
TeTe—plaone
Very truly yours, Signed . 6"'o (X/YZ .
Owne o Property
Addr'ess
623- s 19 a .
e ep one
. oy.fee 0 * 0 0
° ° �� \p�1A1. ENG.iNFF�,o ..
e u` � $ RO�Fpw��J
e �
o ?7846 0
-O
4'
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION-.. OF • ENVI-RONMENTAL� HEALTH= SERVZCES -
COUNTY OFFICE BUILDING,,CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Virginia Versland Adaress: :2k9 No. l ddletown ..•Nanuet,,- N.Y,
Located at ( Street Trail of the= mplvbc : Ya'P -139tLock Lot 26
6dicate nearest cross street).
Municipality
'Putnam Valley
Watershed Peekskill
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Vater a er ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1
442 1:57 15 244 27.5 3.0 5900
2 1%57 2:13 16 27.5 30.5 3.o 5.33
3
4 °
5
_... ._ 1 201+ 2s22 18 20,25 23.25 - - 3.00. 6.00� _
••r
2'` 2s2z' ' 2s42 20 23.25 26.25 3x00 6.67
3'
4
5
1
2
3
,
4
5
Notes: 1) Tests to be repeated at same depth until approximately 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.
TEST PIT DATA REQUIRED TO BE SU3MIT-551%'TH & LICATION
:;17 � 7-,17 , -, : 1. - . - :z
DEPTH HOLE NO. I
G.L. _Toposil
611 Toposil
121' fthdy graved....
1811 some larger stones
24
3011
3611
4211
4811
5411
6011
66"
7211
7811
8411
HOLE NO. HOLE NO. 3
Topsoil Topsoil
3 Topsoil
3 Topsoil
sandy gravel sandy 0mviel
some larger. qtoixw�z-A some t r stones
� 16 �
INDICATE.I=L AT WHICH GROUND WATER.IS ENCOUNTERED None
79
F;-LEV RISES -AFTER T
-INbICAT'E` LL-, TO-WHIM? VATER-- IZVE-D -RISES-�' -,BE-1NG-ENMATERED-
-.1ESTS MADE BY John S. Romeo Date July 99,1972
DESIGN
Soil Rate Used 8-3-0 Min/l "Drop: S. D. Usable Area P VQ 9#,,.5000SF
3 S 900 sonry.
No. of Bedrooms Septic Tank Capacity Gal
Absorption Area Provided *__I$0 L.F.x2411 5b"
Name Bonn zi, Itomeo bIgnature kD1M*-L , wiwlm
Address I Nartbridge Road SEAL-0% P�
Peekskill. N.Y.,
THIS SPACE FOR USE BY HEALTH DEPART?MT ONLY:
Soil Rate Approved Sq.:'Ft/Cal.
Checked by
Date
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