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02827
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02827
l. 'Located at iq.�O Tax Ma
0 he; r Lot"
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stern WiIA
qsParate , S6weragfe'SV 'ijr Address
N2�1i*LL-
SA L L i
c
Consi-stirfg -of .66 ;Septic Tank and
Othbr hiquiiements,
Water -supply: - Public- S6001y From
ci A!,
Address �
7
3"
Bui iding Type
NP_ of BedrQOMj.
a 'qT
Control Been 6d
Has Erosion'. Completed?
V certify, that as lists,q serving the above premises were constr�uctetl essentially as show
ittacheg), 0 d�-in acct r ance.,W !th thk.,stardar,d i rule; and,regulati and e. perp
Date t-CFEITICO by
Adqress Use •
An y "6erio"n occupying
"premises ser_. ved b y
the
. a'b. ov6, e `.
-s' ystL em. - ( s) " :s q,a'9 ll promptly
,iAks such ac ton as
condIt igns ,resulting 4 rOffi' Such usage Approval jh'separate t�
availabieand 6e,ap"p_r6v'af,O the .private wa ter supply?shall. become null and ` V
ol6f when en aL publ
n o' f
subject. to mo I ica oo r c ange w en,, in he nt of. the' - missioner o Health, sti(
Y05.
12
Psewt
s,_ f�� coTp1q;ed work (copies of which. are
.`the.' Putnam -County bepartnisht4CHealth.
P.E A.
License No 6 55A >
k4t IL41. H
MU he correct' ion,.'of an-y—unsanitary
ai's6on as a public sanitary ecomes
r sp�Ivs�!
Dly wico m,es, .available. '-Such appiovals are
modification or change Is nect
Ory.,
�bate By
A-
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WATER ANALYSIS REPORT
SAMPLE NO. 4535
SOURCE: Charles Dere faucet -well
West Shore Dr.
Putnam Valley, N.Y.
COLLECTED: June 30,1980
BY: P.F. real & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result indicates the source of the sample was
of satisfactory saxitary quality whtx the sample was colltcttd.
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July 1,1980
i
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Bickwit P. E.
Director
_ TOLJPT OF PUTNAM -VALLEY .
mow. YT�� .PV�.� a o..ir..� �. � ^�' +v ..a W+ _ re r.V+ ..- .� -�� ... sC•a. . - . •q.•w .�. ^-'_1 , -.e..b a_e +.Jw�,— c_�:L.'•reaearva.a oww.e .- vm r..
WLTLL DRILLERS LOG ATTD REPORT
WELL DOCATION West Shore Dr.,Putnam Valley, N.Y. 10579
street section block lot
WFiLL OWNER Charles Dere c/o G. Lerner, Hilltop Drive,Putnam Valley,NY
name address city or town
WELL DRILLS P.F. Beal & Sons, Inc.,- 4 Putnam Ave., Brewster,NY ('10579 —
.name address city or town -
_-CAGING EDETAILS
YIELD TEST -
WATER. LEVEL
SCREEN DETAILS
Bailed
Measure ?:rom land
surface)
�ehgh: Lr2 feet
or
Pump x . mped_H .
- :._6;_Statit: j ft
Make.:
�., ;�-,- -
-
--
eri: Bailed . ,.
`
� ..... �
'th '.
•lot
Inches .:
Yield: �-1`5 -..GPM
r Pum ed , =. ft
.:.. Zen . , -_ :.- Ft-A,ize
_..
Czrrd Heavy Duty,
- - -
"AI; iEPTH -OF WELL. 28.0 Feet
1
)epth From 'Give description of formation penetrated, such.as: peat,
Dround Surface ', silt, sand, gravel, clay, hardpan., shale,- sandstone,
ra.nite, etc. Include size of gravel (di ameter and sand
fine; ..medium ,. -- course) =, color: of material,: structure
packed;._ cersented, = soft: -"bard): -_(ET .Oft: to 2 ft
i irie; *t� --
�e to eet �'_ormation Descri tiori :--Skc ! tch -- -exact - location- of.- wel1=.ta -
1 at least two permenant - La.ndmarhs
O to 30 Arilling in overburden cl.y & boulders
30 42 (Drilling in rock -set casing grouted
280 [Drillina- in vonk-
)ate Well Completed -- 1 /?5 /80 Date
Well
2
of Report 1/ 80
Driller Z.&Joel,�
sign tune
{
,u
a,
._ ... - ._. .:,.,:•.vcc o.r.:.c: ..,s,u . -.,... , w• .c .. - :.... -e, ..�->: = %av :. -- .- ..- .;e„'_ /`-
fl Lr2 D c y M I�
Owner- or :P',urcliaser.,of Building a Muni cipa ity
Z
Building Constructed by Section
Location - Street Block
/L C.
Buildin Type ° ¢° Lot
GUARANTY -OF SEPARATE SEWAGE SYSTEM_. 4
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 th`6- ._Dir.ect_or of the.. Division of. Environmental _..Health Ser-
vi�es oz the 'rutnan���t�urt��r�'Uepartmen� of nea1L'n.'9s -_t0.. -whether .oz; .not' 'i�iie
failure of the syste to operate was_r.-ca�ised by .the willful or negligent
act of the occupant f the building .uutlizing the system.
Dated this day of _ 19 x;Signature A_e
_._h,�- _ _ _.___ -. _ _ �: eat.. . •.,_::�..<......�,Ti��a.Pw_, . �,- �.:.....,....<- ,�.,,..._... .... .. - -.. -_
llt' corporatio glue
/�) /��a ad es
/+ O1
- - - - - --- - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS
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
`y .
4,
-Y
0 4WAJLTH----
UNTY DEPARTMENT -_-TUTNAM -,-CO
_7
Drvis <on of E qvirgnmenta. Health -Ml
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%
d6NStRUdf4QN. PERMIT. . FOR _'SE"GE_1, 11,
V—,
Town. or illage
-."..'.Located at Z�A ky,
.4.
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Owner j, A(
zi
.:4 Al A34
It C��Uft;& - - _-4— I
J
Number of: Bedr 6ons Des gn� I nA
> Total Habitable 'S . p . a ce Square Fe
et j
Separate Sewerage System
To. be constructed by dre S'
A
,YVater' Supply: -t _ Public 6PON From—
A
'Su p b6 drilled t -
lk
Address
other Requirements
W
I represent that I am 0
n the 'design afid�`-locatioqn sp)f- the pro 6se ern(s);, 1) that the siparatw sewage 'disposal system
- the u
v6 'desdriiioid will ri -,a meF!q Mennn7xx�.,f p Rh _.standAfdi,f6lds
,n
an r u at ions
Depart -'--,'And thaVon-corn h6r06f,j,.1 satisfactory 6'e.- 17,
�&n Y 6nt Health nam
U'l6niltied It t art aZygi;M7, 9 e r s orza�s!gps:toy the At
0 , : I
place ..�e� s * i : i � - r
. I � .: I S" -'edi'tel 'f 1,
0 , rn he te
co said, `seWage-� disp�sai_ly` - u ICRII� a s'imMediitely'f
`in 'good`operating;
ance . of -.the -approval of the., D&Iificate pi onst6ctiow Cdrnplia.up :9�f the 0 no I e irei6-�,i)'that the drilled well desc 'a ove
"will elbcati,das-s�n6n. h 'sa I Will 6dij—lations
I wD At id well I ac da S,' rules and r, V the -',*:Putnam. .
County __ Department rhdrit of'� H
H LT H
7,
k.E�.:: R;A'.!"'-
�,Izigne
C -
bu
oi
Ada- ffirens No.'
0 urid taken from he..d rol S Of the. building has'li6en er ro 'aiid w
APPROVED -.00-R CONSTRU'CTION: This appedval'eic ires'
Date
'�Auseor may �be amen or modified f construction
requires a A b h. Any change :or o cons
revocable for; ed nia6iiisary
'c' -
new permit Approve for disposal of domestic a
Date Z2
y
-.7
I UTN , -OUN -t ®EPt�RTME1tifT tOF HEALTH y
.: 4 �ru�1tg�cion- of �Enwronmental. Heali'h Servrc s, Carmel N � Y 10512 �
CONSrR, UCT10iV- PERMIT , F,.OR- SE -WAGE ;UISP „OSAd SYSTEPfl ,; Ff Putnam rF Valle ^ N Y
a Town or Village
c k..h 8 �7 piU Kt rr��li 'd' �•f %�� C -
i_uca u •'d. 1br"� ° cd- k�� -c—� � t�r"�c�tttt i`ltEkitk�m �
Subdivision K &K Estate`s March `'I2� 1976` I_ot two Joe Dere
o:vitner CharlesT Dere 607 Broadway
` 43 599 Cedarlurst
Adtlress
Building Type Otte f aml ly Lot Area .
3: ab
18,00
Number. of Bedrooms Design Flow Total Habitle space —Square Feet
Separate -.sewerage system to corisi
sez of . '- I-i nn 'Gall. Septic Tank antl,.sT ® •
To be. eon'trw:ted; by. :Lyles Blaylock Ada.ess Katonah, 'New York:
k
Water Supply Public Supply Fiom
'. Private Supply to be drilled by
Beal
.Address
Other Requvements',
County Qepartment ` of Health and that on completion thereof a Gi
,be submitted to the Department and a written guarantee `will beef
place :.in `good operating condition:,_any part of Said sewage dispose
ance of the approval of, the Certificate of '-Construction:Compliance
will be;'locatI d as shown on,the approved plan and that saitl well will be,
County bepartment of Health
Dere Jan 1`0, 1'97$ r signed
AtlilCess Lakeview Dr1vE
i1PPROVED FOR `CONST:RUCTibN This appro"I expires on ear
revocable f cause or. may De amended or. modified;when con tlered
r w permit .. -Appr o d: for disposal of dourest' y
Dat By ,
zte of Constructio Co pl an 'ti y t theTommisiioner of. Health will
IV d the owner his's cue is; h ok� g ' by he alder, that said builder will
em 4, uring, the perio o ( '"� ehia ly t flowing thedate;of the issu-
the orig ys o pairs the eto 2j,t t.th- :diillead.well described above
letl,
in, cordanc `,wi e_ Odards• pule' arN� ulations' of the. Putnam
b of c
P.E R.A. X
North 1=2543
License No.,
the a .issued unless construction; of the building' has; been, undertaken and is
a s ner -of Health:- Any change tor- a1 ration of; construction
e'' d/ e� ater - supply only.
Title
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INITIAL SI`Z'E INSPECTION �
Yes .
No
Comments
Property ].fines or corners found ; ..
.
Can estiny-,te. house location . .
Will driveway need cut . . . . . . . . .
Nlust trees I 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 HOLD DATA
,Depth:
Water elevation: �-
Rock elevation: CD �
Soils' description: J_a�d
-- Date :
FIRU SITE INSPECTION Ins , by:
House located where shown on approved plan
_.
SDS located where approved .:
length of trench Measured
Width of trench average
Slope of tile line and trench acceptable .
Room. allowed for expansion trenches_, . ;
Over 50 ft. from swamp,waterc burs e
Natural. soil not sari pp° or . SLJ, area
_ .ufuiecessarily _gray ed ....:
10 Ft. maintained from prop.line and>
20 ft. from house
Separation of trench from house, well
etc.. follows plan .
Number of bedrooms checks . ` . . . . . . . . . .
Stories, brush, stumps, rubble; etc'. , greater
than 15 ft. from nearest trench
15 Ft. of peripheral soil horizontally from
trench . ... . . . . . :
Junction boxes properly set
Could surface run off from driveway, roads,
.ground surface, etc. channel near SDS ,
area . . . . . .. .
Does lot drainage - arpear O.K. in area .of SDS
FINAL GRADING OF SITE ACCEPTABLE
.. _ - • 11rSV1,1,W 1.1 llSla •111',i',7. .. � ._
(Mr:ets 5trl . Remarks "
ea 1.0
o
u0Ci?ir?i ITS .. _ ...., .. . _. _ _ .....
Fouse plans 0.K.
D:sig;n data sheet 1
Pores presoaked?
nn.', 3011 -pert test depth `. .
:Coast . results for 3 runs
D. Hole iog 0.K.
Corporate Affidavit for oth -r than individual
Authorization for engineer
Ietter from Water Supply if' applicable �
if variance requested -such noted on plans &apps.
D�-72qAILS
if change is proposed,)
ristirig contours shown show near contours)
Slopes for-driveway cuts, etc. shown
Izater service line location
-Footing drain, etc. location
!op'slope, bottom slope of fill
Percolation tests and deep test pit location.
Se-otic tank size and conformance to std.
house minirrum
KouSe setback shown
Dili stribution box ftg. below frost
Ali -hater within 5Q ft . of PL shown t
Plan and profile SDS
�acllj e,na jL5 closer 2Uu ' _'r
shown. or reference .Trade '-
property boundaries (metes and bounds = clearly sho
EFARATION DISTANCES SPECIFIED ON. PLAN
)' to P. L.
)'*-to Foundation walls
?' to Nearest well
P to stream, march, lake, etc. Intl.expansion
it to Curtain drain
►t to water line (pits -C"-'O
to storm drain
t'to large trees
' from fou o s,( ptic " tank
' to }' roils leadei° drain & . foot"in� cyi
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PUTNAM COUNTY -DLPARTNIN T OF HEALTH
n 7 ^^T� Trt7
A
IUTTTL7 ICTT Tff7 T ♦�7 •: T T �T1 •T, ` !
Re: Property of
Located at
County
Section
.Map of K &K E
Gentlemen:
Date Dec. 21, 1977
_Charles & Barbara Dere
-West-Shore Drive Lake Oscawana', Putnam Valle
map no.
1593 Block - -- Lot 2
states dated Marc 1976 �"—
This letter is to authorize Ben Tagliarini,. R.A.
a duly licensed professional engineer or registered architect X
(Indicate)'
to apply fo.r 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
Department of Health, and to sign all necessary papers on my behalf in*
'connection with this matter and to supervise the construction.of said
Q stom- c y_�to.�ls in-° rifuririity` iai Cii trig provisions of Article 145 or
147, Educ`° the Public Health Law, and the Putnam County Sani-
R.
T"
O�
tary C q
m
Very truly yours,
�. Signed
A 1250:3 k Owner of roper y
Countersigne
P.E., R.A., #_ 1 2543
(Seal)
A ress
North Salem, N.Y.
Telephone
Broadway
ddress
Cedarhurst L.I., New York
Telephone
70T AL
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0014 �
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PUTNAM COUNTY P -'PARTM , IP OF HEALTH l
DWISION.OP ENVIRONMENTAL WALTI 'SFAVICEJ
Y:
,. >.a•. a'I rATA 9I'- SEPARATE SEWAGP4 DISPOSAL. OyT F NO.
�d V :Charles Dere Address 607 Broadway, Cedarhurst •"'L.I. ..N.Y.`
Map.. NO., ;.. '
post d ��
(street Drive Sec. 1593 Moc i�t... 2', ,
Ind I ca neare 0.050 8 - s .
one .mi a noM of sun se l Road . J M
rPeviG!.p% . y' Putnam Valley Watershed Lake' 0' cawa is
SOYL FMCOIATION TEST TA UIR TO BE 3UAMITTEU WITH
a e
b �ri ;. LOCK �ZME PERCOLATION - C®
apeo p o 174 tor E 01i ve
Nye =pie dam Ground Surface in Inchoa
Girt -fit ®p . PifCn, start Stop Drop in ;; heap /fin _�4® . , " •r`
t irachrae Irnchgs Inchea:.
'ONE 12:10/12:40 30 min.:: Full to En?Pty'
'
40/12'i50_10, min' 1.0" 12" 2" .
5' min.
v 12:56/.1:06 10 min 10" 12" 2 "•
9. min
7.
TWO $ 1:15 1:45 30 'min Full o Einp•ty . .
10�� ' 121 kk 2 2 4:."min "
5 i
HRE.00 %12;3:0
30 'min Full to .. Empt y:..; r t
. 12.30/12 40 10 min . 10" 1 :2�� _ 2,r :;:5: min
1,
`1:15 1: 25 10 min 10 ` 12�: 2 ;:5 ' min
77777 77 7
P
GSA ` 8 CrL
N.1 i .a.:a kiFY i• L Iry '
B110tes r 1). Tees to be Mpcated at saner depth' until a rauA t® c
rat6a are obtained At each percq]Ation te4t hple. � dam "o
Ik3PO nroaeurementc to ba ,tt da °saa�,a tAlo. 1pf h6�,erp
I,. I u>,,Jq 1* J i Iii I: ",)I. j I J,., J" Il '.!;'ID A..'. 19.11 ON
l"
t' J,Ulii 01-, ITT
DEPTH H0127, - No. Deep Hole jjojj� . ],,,0. Perc. 1&2 jjOjj,,, No. Perc. 3
G. L,
'611 top soil to of
soft I-nqm Oft
12tf S Oam
2411 loose sand
3011
3611
421t
4811 SAND
every slight track
5
4 If SOIL
of minerals & silt %
6011
6611
7211
7811 (No ground water
84
encountered) '%'
-loo-se sand—_
INDICATE LEVEL AT WHICH GROU1,71) WA'j`ER IS ENC0Uf1T T P I
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER L, ING, ENCOUNTERED
TESTS 14ADE BY Ben. Tagliarini + Bruce Foley —Date Dec. 19, 1977
7
.Soil Rate Used__5_Min/l"Drop: S. Usable Area Provided
-0-0-0-
No. of Bedrooms Septic .Tank c, I Gals. Ty pe mason_ ry
Absorption. Area A-vided By � 250 L. wi h trench.
her
V 1 22 - V
Address Lakeview Drive S�
-
NortFi Salem., N.Y.
THIS SPACE FOP, USE BY DEPARTMENT ONLY:
Soil Rate Approved Sq. FL/Cal Checked by
pate
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