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Home My WebLink About2775DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -44 BOX 23 02775 Cp[OY�t91D2i F!� !� , a ....� ��N.I�S Imo• ell VVIRMODUMMAMIGM072RUM DA6Y1,d Bed&II, I Causal.N.8.14812 W eSwum '� -.sue / �--1fore -4— - M CEM R7CAIM OF COMMUMCE F4ts•It / � —� r�W e- r� 360"" rAM AQ-e, izn 4zi e tea- tat / 2 Tam RYF 6--7 Seek ,� u r f /�� ;/la r �.frr— ❑ ■..Mier. ❑ Owa/Anraat lQar `i l 7 Data d how Anneval NfiaB Addaaaa �G ✓ i �I /l�Ci hf-� �%f J�H�n�rm �!�d. � /e, Sly Date Subdivision AgRroved Fee Enclosed Amn„nr 9111M TRW _S lot Ater -0-6 3 G FB swtb. o _ \I/IWti Nmba d. - DWV Flow G PD ZOG F® MaGO"aa Y =d0uked W`w Fs Y eapl}YYd Maas sewitee s $Lisa g f i1[ ) vl v rte,., get Tow oaaobnpaisd IW — 1 �1 �1 Aa�a /may �' � i✓J a %�G y won raft M!* Ftva Adiaeta an ✓` Meta Sqvtv D1led by 5 2 Addmm Olba IY�iaaaaoa 1 rpreas t that 1 am wholly and completely responsible for the design and krcation of the proposed system(Q1 1) that the separate sear dl sal stem age ve dwaibed will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a ►agu s o Ceunty OaPWWAnt of Hnfth4 and that on complatlen.th@Mf a "Certificate of Construction Compilanea" satisfactory to the Commissioner of Nealthwill M subfhttod to Ma DpWtWANd. and a written gWfantea will be furnished the owner. his tuteaefart, heirs or aselgns by the builder. that old builder will DOM ill gee/ .SWMMg ooM OR. any pert of said sasrap disposal system durkg t led of two I2) veers Imnoediatssy following thedate of the lasw "a of the appvdvat of tflo Certificate of Construction Compliance of the or env Npaire theretoi 2) that the drUM watt d0o N" 06ora wO be loested as shosah oh ties approved plan and that said well will be Instal aN6i1 ten standards„ rules and fee- UMnibt the Putnam Cdwlty D%"�, WARtt Of 11041L / 'l* caw '�/ P.H. !"✓ � * ✓� � — License Nom Lf APPROVED POST CONST91UCTI6N :1 approval eapaes twe y ► at ruction of the building has begin undertaken and is feogoals for CBM Fyg t o anmr4m,d or mddiflad when eons! t W aith. Any change or alteration of construction vgw►es a ne pa pproeed for disposal of dommtic N pply only. I Rue . o� I /�(fl l y ev TRla PUT'NAM COUNTY 8 DEPARTMEN OF HEALTH DIVISI ®N OF ENVIRONMENTAL HEALTH SERyicES as: property c Lt,ocotedl at c o. This letter is to authorize � � ., � 9 1 � v� d7 a duly licensed proifeaaional engineer" or regist4red rchitect� (Indicate , to apply for A Construction Permit for a 0e1p&r.mte sewage system® to serve the above noted property In accordence 'with the standardafl rules or regulations as pro®ulagsted by the Commisaloner of the Putnam County Department of Healthq and to sign all necessary ympers on my behalf in connection-with this matters and to ouperviae the construction of said . system oar aystdsas i dwdfoft t�._ ast If- - T ha- -Ar e?ui- ouz... mr ' A��i�l ® -` -f ®r" 147, Education Lawn the Public Health Lawo and the Putnam County Sani- tary Cede c9'L� cousnter0ignod; d � 1?0 &0 U �/A0 0 # . AA I Wale �7 Very truly youra o Signe 77 ' PUTNAM COUNTY DEPARTMENT OF HEALTH a ' Division of Environmental Health Services, Caimel, N. Y. 10512 . CERTIFICATE :'OVCONSTRVCTION . COMP,LIANCE. FOR'' SEWAGE DISPOSAL SYSTEM • Town or Village Located at — L�"tiEti- lLL KC'J� y_ _a+�i'i* T/1 iax snap . y td. Block j �.- - .- - . -- p Ownel'J' lr/"f/ �I'G� I. . tea! . -.. - Tax Map Lots N �NJ - subd Separate Sewerage SYstpm built .by ! `Tci .A= f Address r',2i r✓�/��A1° �'� s '/ • Corisisting o} Gal. Septic Tank an Other regyllrements . -fW1 a LD1614 ia Dr tf '. &;2`�,,, Water Supply: - Public Supply From PHvite "Supply Drilled By ,Ajodress (:- Building Type �j�i No.. of Bedrooms Date Permit Issued , Has Erosion Control Been Completed? i certify teat the system(s) as' listed serving the era --e ,constructed essentially as shown on the plans of the completed work ( copies 6f ,which are attached), and do accordance with th {ej� ,Ay regulations, ccordance with the filed aan, and the permit issued by the Putnam County Department Of Health. Date. �° °,.' ° fi rb*ao iG� P.E. "-R.A. Y �- ( ^y Address 'kj L""� • O's License No. 272 2 l Any person occupyigg. premises - served by. the ve 'y ` " mp such'action as maybe necessary to.secuie the correction of any •unsanitary conditions resulting from such usage Appro of�* y ,se " sy em shall become null and vold'as soon is a public unitary sewer becomes available and the approval of the private _water 1'li 11 'eco d' Id`when a* public su becomes available. Such approvals are subject to modification or change',.when, in the ner o"ealth; such evocation, odification or change Is necessary. Date �_ BY_ Title, 41.. -5868 PEEKSKILL ANALYTICAL LABORATORY 201'Buttonwood` Avenue YML:# 40056A (Corner of 202; across from Hospital) P�- 1skl_1" N. Y. 1 ►5� "6 737 -8777 DATE COLLECTED RESULTS OF EXAMINATION OF WATER: 12-5 -79 OWNER DATE RECEIVED Mr. Harry M 1 alyd 4 P 12 =5 °79 CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE.REPORTED Tinker Hill Rd.'' Pitnam' Wley,.•New. York 10579 12 -7 °79 SAMPLING POINT Tinker Hill Road, Putnam Valley, New.York BACTERIA PER ML. (Agar plate.count at 350C). $ COLIFORM.GROUP (Most probable No. /100ml.) 01in ) RD ESS, TOTAL -ppm -DETERGENTS- mg/4 -NITRATES (as N) - mg /L IRON, TOTAL- mg /L AMMONIA,.FREE_("s N)-mg /L_ These results indicate that the water .was YES of a satisfactory sanitary quality when the sample was collected. - . A. H. PADOVANI, M. T. (ASCP) ;.4! 1 N •E ADDRESS COMPRESSED CABLE OWNER ' ROTARY I AIR PERCUSSION PERCUSSION (SpedfT) ' WELL COMPLETION REPORT PER FOOT / Pl6TNAPJI COUNTY DEf'P.RTP ICPdT 0 HE/1LTt r CASING C.'.Q� -YE6 �' (tlo. 6 $floor) �.�l.Gta��.i'� (Town) Division 6f Einvironnp7ntJl IICJIltI ;n•r V:CV9 ° .• THREADED R WELDED JFf(„i COUNTY Of -FICE UUILDING CAFIAtEI, NEW YORK n)' 7bit rcpo.t is to be comp'etrd.by DORtESTK ,7 rtrn tU:,_I l r"Wiln'iJuO. t "r '7t f -Un t O� "analysis of water sample indict ing winter is of satisfactery biCIC631 quality before certificate of construction compliance is issued. TEST CAILED REPORT MUST BE SU.MMITTED VATHIN 30 DAYS OF t:CLL COP•SPLETION �'1 y ', WATER QfdEld ;.4! 1 N •E ADDRESS COMPRESSED CABLE OWNER ' ROTARY I AIR PERCUSSION PERCUSSION (SpedfT) ' CASING LENGTH (leer) I DIAMETcki'mcnes) WEIGHT PER FOOT / E r CASING C.'.Q� -YE6 �' (tlo. 6 $floor) �.�l.Gta��.i'� (Town) (Lo► t: r.:Cer) OF WELL THREADED R WELDED JFf(„i L-'L C��C A�l .i'!� ' DORtESTK 1 BUSINESS R ESTABLISHMENT CJ RIA CI TEST WELL PROPOSED TEST CAILED F COMPRESSED AIR USE OF ', WATER QfdEld , Depth of Comple Jd well INDUSTRIAL CONDITIONING OTHER SUPPLY 4 K'1: (Specify) LENGTH OPEN TO AQUIFER ( leaf) ',SCREEN �;. . .3fPTP1 iCGM LAND SU +r ACE - y�, „ FORMATION DESCRIPTION If yield wos tested at diRcrent depths during drillin7, lio below FEET GALLONS PER MINUTE n !1F -WM Fkotcn exact lo:a::on of Fell wi:n oistinces, to at least two permanent mramsrl(s. N.IT Iti i` • !d. 1 T .. UAVC OF I((_1'ORT I WELL 011ILLF:R (Signature) �� .It 7 �` -� ate• -' DRILLING COMPRESSED CABLE ❑ OTHER '< SQUIPMENT ROTARY .L11 AIR PERCUSSION PERCUSSION (SpedfT) ' CASING LENGTH (leer) I DIAMETcki'mcnes) WEIGHT PER FOOT / E r CASING C.'.Q� -YE6 �' eel, THREADED R WELDED YES R NO .%VAS Q YES LJ NO YIELD HOURS R ",,J; - G.P.M. f YIELD (G.P.M.) TEST CAILED PUMPED COMPRESSED AIR ', WATER MEASURE FROM LAND SUkFACE— STATIC(Specnyfect) DURING YIELD TEST [toot) j , Depth of Comple Jd well ^' ' &EVEI in feet below fond surface: 4 K'1: MAKE LENGTH OPEN TO AQUIFER ( leaf) ',SCREEN .- DETAILS SLOT SIZE DIAt1ETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (toot) (:oat) PACKED: grovel pack (Incnes): I10 �;. . .3fPTP1 iCGM LAND SU +r ACE - y�, „ FORMATION DESCRIPTION If yield wos tested at diRcrent depths during drillin7, lio below FEET GALLONS PER MINUTE n !1F -WM Fkotcn exact lo:a::on of Fell wi:n oistinces, to at least two permanent mramsrl(s. N.IT Iti i` • !d. 1 T .. UAVC OF I((_1'ORT I WELL 011ILLF:R (Signature) �� .It 7 �` -� ate• -' i a ,.e��.-. r •'••- y• eu:. ."'"• _ I"'C .. ..._. -:. .:..- .. .,.." ..;_ ;z,�m�j�4,�f•,�� /�'TiI X/�Tl'i'• '�'/Y`��- ""JC"- Owner or Purchaser of Building Municipality Bui ding onstructE by Zr-r L14L Z�� Location - Street/ Block Building Type 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- vices of the Putnam County Department _of a_y Health as to;whet.her or not the _._R, wi�use.ds..uy Lne�wl- ��•u - or rieg ..igenL .. act of the occupant of the building utilizing the system. Dated this /7 day of G 19 ~ Signature 111VA . 140 T i t 1 e c uit'm - Sf ':Z /f/%-CL.�1C._._ If corporation, 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. i ••. s 4 w : R. , Owner or Purchaser of Building Municipality 1 Building Constructed by kCJ�. / r /�.L k�G�i� a i✓ �yrl:7 Z:k Location - Street Block T Building Type 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- vices of the Putnam._.Cou 4ty.._.A.ene.r.tment of. Health as to. whether- cr.no,t -t•he- ..:.':..: ; f i'rZure °oi "L' ie systeiri" co'opera e ldas"'catfsed oy'"the willi'ul -or neg nt act of the occupant of the building utilizing the system. Dated this day of 19 /i� Signature r` Title_ corporation, give name and address) A+q -PC _ . _ J_ THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.7,ETION 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 owner or Purctiaser of Building Municipality 14AJMC6,�V /47-Z�14 . 1 13(_ Building Constructs by �cn --f-AA 1144 Location - Street Block Building Type 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- `' +r: n °�;tnam Cc -un_ - D:e artment of Health as cgT � �,tYher _off �o � Lie_.._ vices- o�- _ .._. failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day y of Uryy2 4 19 6 Signature 6. Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 Owner or Purchaser ol' Building Municipality AleA 4A&I lZr- 7Y Building Constf-ucted by . ................... Location Street Block Building Type 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- _vi.ce.s...of..._.the. ..F.'atnam County.. Department of-.: Heal-t-1hr.,a__s,--.to- -,whg.,t_h or:. no-t- - the igent act of the occupant of the building utilizing the system. Dated this p2 day of 19 ?&7Signature > Title .,7 Ive If corporation, give name and address) Owe 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 1 f E..LL COMPLETION REPORT fPUTNAFJI COUNTY DEPARTMENT OF IfEALTII . Will Division cif Environmental Ffcalth '.vrvicv9 DOUNT•Y.OFFICE BUILDING CARMEL. NEW YORK ` hi- _rcPert ts, to,be_eompleted by v II duller acid su' �. - tCd. :o Co!jn4y_ licafth_- DcoTrtment -to tether: �s�l�;•_ts�� ct'w,f -•� • �- .•..._.Y... fysis'of'wetcr'sam"ple int7icating sairsfactoryhacterial quality before certificate of construction Compliance is issued. . REPORT MUST RE SULDMITTED V- 1THIPI 30 DAYS OF •:ELL COMPLETION) art r1:VM IAN) �141AIIJ FORMATION DESCRIPTION . -Seel 1J 1 ►LI -I _ ._., .-- .— ._..._ _. -__ ��- E. JL e Of giold woo failed of di(Teront depths during drilling, lilt below FEET GALLONS PER MINUTE Skotch exactlocat ;on of well wish oist3nces, to at least two permanent lanamsrxs. I NL fl�i I -_ - - DATE OF ftLF'Of3T WELL VAILLER (Signature) _ '�i`5�^•y7^ �1 � N .E ADDRESS OWNER BOCATIOfd OF M /Ell (tlo. 8 Street/ ,r.✓- � ' Town - - / ( l (Lo► t:;;RocarJ J � A> BUSINESS ❑ ❑ ❑TEST PROPOSED D01.1ESTIC ESTABLISHMENT FARM WELL USE OF WELL SUPPLY ❑ INDUSTRIAL ❑ ❑ OTHER ) CONDITIONING DRILLING � ROTARY OMPRESSED �iAIR ❑ ❑ (Sp�fyfOUlnAENT P ERCUSS ION PERCUSSION (Specify) • CASING LENGTH (test) - -J — DIAb t 01inches) WEIGHT PER FOOT 21 D VE SHOE wn5 A SING G =OUT ? -- DETALS THREADED WELDED YES ❑ NO YES ❑I NO YIELD ❑ BAILED ❑ HOURS G.P.M. ; YIELD (G.P.M.) TEST PUMPED COMPRESSED AIR VIATER MEASURE FROM LAND SURFACE - STATIC(Speci /ytectJ DURING YIELD TEST (Jost) Depth of Complef:d Well BEVEL in feet below land surface: � - MAKE_ LENGTH OPEN TO AQUIFER (feet) SCREEN - DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (Joel) (roes) �- PACKED: gravel pock (inches): Ito art r1:VM IAN) �141AIIJ FORMATION DESCRIPTION . -Seel 1J 1 ►LI -I _ ._., .-- .— ._..._ _. -__ ��- E. JL e Of giold woo failed of di(Teront depths during drilling, lilt below FEET GALLONS PER MINUTE Skotch exactlocat ;on of well wish oist3nces, to at least two permanent lanamsrxs. I NL fl�i I -_ - - DATE OF ftLF'Of3T WELL VAILLER (Signature) _ '�i`5�^•y7^ �1 � :;G IYPA4EPJT U ROTARY a AIR PERCUSSION Li PERCUSSION CJ (Specify) LENGTH (lee() i DIAMCTAR(inches) WEIGHT PER FOOT D vE SMOE �'�4S A ING G(�'O;I:Tr6 I y.`CAS11•!G / — "'- -- - Li`.I THREADED ❑WELDED YES ❑ NO! YES l J NO /. &TAILS - °— ---- -��- -- -- t d �f9Clb HOURS . G.P.M. J YIELD'(G.P.M.) FAILED D PUMPED COMPRESSED AIR aLa �Si a MEASURE FROM LAND SURFACE —STATIC (Specilyfeet) DURING YIELD TEST (lost) P' om I Depth Of C ;.,tsl�i[R• p p .,od Well ` •QERP &l., in fact below fond surface: / E (4. nkILS .$LOT siz DTH AOM LAND SURFACE( 4 LENGTH OPEN TO /.OUIFER (feet) E DIAMETER (inches) IF GP Diometer of well including GRAVEL SIZE (inches) FROM (feet) TO fleet) ,AVEL PACKED: gravel pack (inches): FORMATION DESCRIPTION Skotch exact focal:on of well wilt, aisr3nces, to at feast two Permanent laaamsfus. 4X, • 4'. tf Yield wos faded of difTeront dept4s during dr;ll;n. 40 bolow "FEET GALLONS PER MINUTE } n tQ WLII�UM +j U�' OAT 'E: OF It 110AT wrl I rmil I Fn min yy o ° [ C�a COMPLETION 'REPORT PUTNAM COUrVTY. DEPt.RYPSCPdT OF I4EALYf Division of Enviionnrantal Ifcalth ;.rrvgcus ' COUNTY OrFICE UUILDING,. -. CAft.41EL., NEbsl _y.Oii.K -,_.. 4 4 4o_Yh r 'wi h lab °e,��:4; tcs':"�� crs.°+T;�fcC ^- .byarr! =!i LrSl'�CP ciidj ik' pct, u" O olinYy' lical> i Ueliir men " r: �' c� :^ 4 Oratory r��rt Of analysis og,tivater sample indicating water is of satisfactory bacterial quality before certificate of construction compliance,is Issued. REPORT MUST RE SIX�tti911'YED WITHIN 30 DAYS OF I:ELL COP.;PLGTIOIv c N E ADDRESS }n ®CATIOPd. �' 010. 8 Stioot/ •,1 "... ;,r'- (Town) (Cot I:�;naefJ l� tPtEll r� +/f.?" -51 BUSINESS - C� QZtO 04ED DOMESTIC ESTAELISHMENT FAR)A TEST WELL "`Q➢SiE �� ir,., ;4PE�lil PUELIC ® SUPPLY El INDUSTRIAL AIR ® CONDITIONING OTHER ® (Specify) £s'``" ®ROLLtPIG COMPRESSED CABLE OTHER :;G IYPA4EPJT U ROTARY a AIR PERCUSSION Li PERCUSSION CJ (Specify) LENGTH (lee() i DIAMCTAR(inches) WEIGHT PER FOOT D vE SMOE �'�4S A ING G(�'O;I:Tr6 I y.`CAS11•!G / — "'- -- - Li`.I THREADED ❑WELDED YES ❑ NO! YES l J NO /. &TAILS - °— ---- -��- -- -- t d �f9Clb HOURS . G.P.M. J YIELD'(G.P.M.) FAILED D PUMPED COMPRESSED AIR aLa �Si a MEASURE FROM LAND SURFACE —STATIC (Specilyfeet) DURING YIELD TEST (lost) P' om I Depth Of C ;.,tsl�i[R• p p .,od Well ` •QERP &l., in fact below fond surface: / E (4. nkILS .$LOT siz DTH AOM LAND SURFACE( 4 LENGTH OPEN TO /.OUIFER (feet) E DIAMETER (inches) IF GP Diometer of well including GRAVEL SIZE (inches) FROM (feet) TO fleet) ,AVEL PACKED: gravel pack (inches): FORMATION DESCRIPTION Skotch exact focal:on of well wilt, aisr3nces, to at feast two Permanent laaamsfus. 4X, • 4'. tf Yield wos faded of difTeront dept4s during dr;ll;n. 40 bolow "FEET GALLONS PER MINUTE } n tQ WLII�UM +j U�' OAT 'E: OF It 110AT wrl I rmil I Fn min l -�s• PUTNAM COUNTY DEPARTMENT OF •HEALTH: Division of Environmental Health. Services, Cannel, N. Y. 10512. CONSTRUCTION :PERMIT FOR SEWAGE DISPOSAL SYSTEM _ ,J,qm f►t;L � 4u wn or e ', J • 9 ^.v .mod .. j• ! .'�i ._" �`d) v ! A r: �A' N " E� Block Subdivision Lot Job j� .l T �A/ Owner Address d Bu•ildih9, Type L Lot Area w' G' _ a ��r' ! Number of Bedrooms - Total Habitable Space Square Feet Separate' Sewerage System to co ist of Gal. Septic Tank 0o lineal feet , ., _ width trench To be constructed by _� �C4� Address 1- 1 Water SupP1Y? Puplic SuPPIY From Private Supply to be drilled by Address- Other' Requirements' ,:>A / f I represent that) ,am wholly and comple ely responsibl ®fort e ;above de''scribed will be constructed,as ,shown on the approve tier ^County • Department. of Health; and that on completion t f ;.be submitted `. to the Department, and a written' guxan he,. "place in good .operating ,condition any, part .of said `se i p r g "ance,of the approval of the" of Constructio plia n will be located as shown on the approved . plan and that sal will. cc d CoUnty. Department of Health. YY T, Date Address Z APPROVED FOR CDNSTRUCTION This;approval expiry one ei revocable for .ca a or m be amended or modified wh cons red!n ti; ' ' squires a new exm Appro ed for disposab ofd me /J)+, sanitary'sewag a r rh roposed system(s); 1) that theaeparate sewage disposal system ordance with the standards, rules ;an regulations o e ,..0 nam - 1on' Compliance! satisfaciory to th'e Commissioner of Health will s successors, heirs or• assigns;by the builder, that said ,builder will iriod of two (2) years immediately following the date of the issu- m or any repairs they ; 2) that the drilled well described above :e. with a star ules and regu a—Ttions of the. 'Putrlam P.E. R.A. .� = 37, License No., unless, construction of the building has been undertaken and Is o Health.. Any change It at onstruction . e t pp only • t 01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN-TAL- HEALTH SERVI-CES Date Re: Property of. 1-4 rrle Located atzz,�) Block Lot Gentlemen: This letter is to authorize ST -AN L I LANDER - - __ a duly licensed professional engineer �o*r 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 promulagat6d by the Commissioner of the Putnam County Department of Health, and to sign all necegsary papers on my behalf in connection with tnis matter and 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 Sani- tary Code. Very truly you Signed Owner of Pfroperty Countersigne V A Addres's' P. E.-, ft*M;=o 0 ANDFR 9 � E in �@ elephone ry &'r Addr@W%Bmu-�-' BOX 267. AMAWAM K Y- 10501 'Telephone ' _ *" Tlmq.). by It 1Z 'Po I Pr (?p a.r t y 1. J. I I C s ar _Coxnqz j J.,03)n Vill drivcway n c, d cut 0' 0 0 0 0 0 9 be 1-Cm Oved-note th"'n 0 0 _fs deep hole of ontire SDS' area A(7,dJ_1-1J_ona)_ hol.cls. nccdcd. Q "Lifficient: ;)DS ,--rca avaJJa,1.)J.c cor)sidurii),, (1r:j.vew,,_-iy - cu-L-., house .1o6atio.n. separation -L:,-tajjr,e 0 etc. o a 'o a o Dopth: Plater elovatioli- 0) Bock elevation: 0 Date FIRAL SITE, PISP CTIODT -Tns-D. by*- House located -viher-- shown on approved plan _10C.atc,c_l,where approved e o 0. 4 0 I% 12-ne and' trench accept.able Sl op of tj T )ver, 50 "t - fro-ii swam v.,atlerco-LLrse' 0 a Room al1oaed for expansion "Llrenches. vlatural soil not stripped or SDS area - unnecessarily graded . . . . . 0 0 0 a 0 A - inta-* -i—d f a.m prop.2ine and yep Ir 2 i Uon of trench from house., well etc.' f oll o-r. -, s plan o 0 0 4 0 lmibor of bedrocms checks 0 e, 0 a a 0 0 .tCnQs brush StUNIMS nibble etc. 'reater I stumps, 9 tban 15 ft. from nearest trench a o o 5 FL - of peripheral eral soil horizontally- from trench e o 0 0 0 a a a a 0 0 a 0 0 0 0 dnc,-tion boxes. properly set Duld sm-face run off froi-ii driveway, roads,, gro,und surface etc. clia.-mael' near ISM 1 0 t. 0 areaa o o o a 0 0 ..0o, — 0 0 0 0 '0 0 a 0 )as 16t dr. ain_--r-,-_ anucar 0. K. in area of SDS UIML GRADING OP.SI'.PE, ACCEPTABLE o DOCU vMNTTS House plans O.K. De§i(,n data sheet Mina 30" pert test depth Co nst. results for 3 runs D. Hole 1 og O.K. Corporate Affidavit for other than individual I' Authorization for erigiileer I :utter from Water Supply if applicable MIA I If variance requested -such noted on plans & apps-, I I - DETAILS if change is proposed, ) Existing contours shown show new contours) _ Slopes for driveway cuts, etc. shown A I i Meter service line location — Footing-drain., etc. location I i Top slope, bottom slope of fill I i Percolation tests and deep test pit location i 1 02 Septic tank size and conformance to�st • _ Q A � 3 B.R. house mim..m m louse setback shown I �1� j �- ,Z�1�,71,.,! 1_Ji � j )Lill l 1. 1�1 7 i r -" t• ..._.... ..,..... -..... ..... .___. F'" --.._I - _._.._ __.._ .. -. di wa ber wi �ij i n :)v i u. of FL bhowii Plan and profile SD All other wells and SDS closer 200' shown or reference made Property boundaries (metes and bounds - clearly shot- i �PARATION DISTANCES SPECIFIED ON PIA '- )' to P.L. )' to Foundation walls I V I I to Nearest well I i >' to stream, march, lake, etc. incl.expansion i' to Curtain drain 1 to water line (pits -20' I I to storm drain I. ' to large trees I ' from foundation to septic tank I I r ' to pipe from leader drain & fooling a rain !'- PUTNAM COUD17k DEPARTMENT OF HEALTH DIVISION OF ENVIROVfvENTAL HEALTH SERVICES � C0�,1iy jn OF F1 I01F BL ILDlI'rU,' LAR�i��, `iV .:_�.y= _:: -TO 512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE =LVOL " Owner nlo�2�vV -- lTi� Address7/_,vK'E4 rLC. /(e_. Ay ,ZOyW of 011r'AIA .ac Located at (Street iW416,e 11,L4 ®A-,o . Block I Lot K t9 n arq✓ VAz44, ross street) Municipality o '® ' cv, W atershed6�Cr�u� LLALti �o SOIL :;PERCOLATION TEST DATA REQUIRED TO BE -SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME-, PERCOLATION PERCOLATION RUM apse Depth to Water water ve No. Time From Ground .Surface in Inches Soil Rate Start -Stop Min. Start Stop . Drop in Min. /in drop Inches Inches Inches -26 3 2 t �T �- Zi 2 3 5 Notes: 1) Tests to be repeated at same depth until approximately, equal soil rates are obtained at.each percolation test hole. A11 data to be submitted for review. 2). Depth measurements to be made from top of.hole. TEST PIT DATA REQUIRED TO BE SUBMITTIM WITIT APPLICATION DESCRIPTION OF' SOILS -IN TEST HOLE, S DEPTH HOLE NO.. HOLE NO.. HOLE N04.06! G.L. 6 cell,, 1211 24" f1 04 3011 3611 4211 4811 511 11 j .. .. ....... 6611 7211 84't MICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE I=L TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 'TESTS - MADE BY Date 2 DESIGN Soil Rate Used DUn/l"Drop: S. D. Usable Area Provided '0� No. of Bedroom s Septic Tank Capacity. Gals. Type Absorption Area Provided L.F.x24" 56" T—rench. r! o i Amng:p Oth Z lYCLlI1G BOX 267 Address y z;dIrL 10501 THIS SPACE FOR USE BY HEALTH DEPARTPTNT ONLY. Soil Rate Approved Sq. Pt/Cal o 5athal -pd-by, _Date 11