HomeMy WebLinkAbout3001DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
62.17 -3 -61
BOX 25
03001
I'
�
I
r r.
y
J
`
��
T
IN ,
:`
��
� 1
T+
I
'�
IN
.���
I� or
-
I
-.
.
I ,
�~
03001
'PUTNAM COUNTY DEPARTMENT ' OF 'HEALTH pero,it a' tl U'l k
/ Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTR CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
2/
Yawn or V5 age" —
—
Located at jef > Tax Ma' Block yet
Subdlv_lsion Subd. Lot 0 l
w
Renea _r> v
__.. Re iaion
i
.. .Owner.Addresa , ;jT. t„' °• '� °.<� _ - %..:.. -. ....._ :: - %�/j" _ .._........, v-
T- : t. +- , �a • 0—Date Of Previous Approval �'d9M
Building Type ti�1 Lot Area �. �� �% Fill Section only ❑
Number of Bedrooms _ Design Flow G /P /D P.C. H. D. Notification Required p
Separate Sewerage System to consist of / �U Gal. Septic Tank and • �`, l% d �`y p w;41e- de.s
To be constructed by •w Address
Water Supply: P blic Supply From
Private Supply to be drilled by
Address
Other Requirements
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis oral system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Complian e" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his succ igns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the perio t�(yv 2) s ediately following thedate of the Issu-
ance of the approval of the Certificate of Construction Compliance of the original system ►ra tttq( t that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordan wig K r� r: a and regu aZ o�{T -ns of the Putnam
County Depa ment of Health. (�
Date Signed h
-;� ' P.E. a �j A.A.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date izs d ~91 co stru on of ffif)ilding has been undertaken and is
revocable for cause m may De amended or modified wharf consideretl necessar Dy the omiAi o f i� change or altmetkfn of construction
requires a no permit. Appro for disposal of domestic ar wa e, or '- �'Lwee°
Date By 0 s�lU�,�'�'Tltle
Rev. 9 -81
u
Permit
jl 1
�•" ` ? " J Y PUTN AM COUNTY DEPARTMENT OF HEALT
(7.Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE UISOS.,L fJ slack ��- tct
- Y-) j.j 4 Tax Map —
L/ Revision __❑
Located at Subd Lot M Renewal _❑
Subdivision J� pa9� �� ✓ Date Of Previous Approval
Owner /Address Fill Section Only ❑
{� Lot Area -
Building TYPO 7 t �7�/ _ P.C. H. D. Notification
Design Flow G /P /D
Number of Bedrooms — -- -►� Gal. Septic Tank and
Separate Sewerage System to consist of _ ---' -- Address
To be constructed by
Public Supply From
Water Supply: -�
Private Supply to be drilled by
Address
Other Requirements that the separate sewage dis oral system
ro osed system(s); 1) re a nam
responsible for the design and location of the P P standards, rules an regu a ons o
1 represent that 1 am wholly and completely o li ag isfactory to the Commissioner of Health will
above described will be constructed as shown on the approved amendment there to and in acctj,g0 o i Oli4) �eAo igns by the builder, that Bald builder will
and that on completion thereof a "Certificate of ConstructisgrP�FFrZZ88�� 11 gi�mediately following the
of the Issu•
County Department of Health, �odo$s ,M�
be submitted to the Department, and a written guarantee will De furnished the owner, reto) that the drilled well described above
rt of said sewage disposal system during thAa ire r8 of the Putnam
pace in good operating condition any Pa nog- Q,.ith a sta �S, r as and regu a ons
ante of the approval of the Certificate opan and Construction wellnwill beenstalled l aycco> t a 4TH W of
will be located as shown on the approved �- ^ to a _
County Departm nt of Health p E, R.A.
u
�✓. � ` ~ r 5
°p6•a
/ Signed ° e icr a° License No. 1 G' ..J
Data Al r se. ° • o x
Address ° S� rife soco ��J61, 111he building has been undertaken and Is
Tres one year from the date +Tssu 49 ¢ o INbi eAny change or alteration of construction
i APPROVED FOR CONSTRUCTION: This approval exp
revocable for cause or may be amended or modified when considered necessare b^ the Con>�ni sao°n�asa
requires a new /permit. Approved fo disposal of domestic sanit caw ( Title C �
Z( A 7._` G� BY
Date l
PUTNAM COUNTY DEPARTMENT OF HEALTH Engineer to Provide Permit a
y Division of Environmental Health Services, Carmel, N.Y. 10512 Engm
on CERMCATE OF COMP
CONS Ui ►v.: � zr- ? i ^ !3 c� m A E DLSPt1SAL SYSTi;A!
/t Permit ®a
Located at ��/7 'Y i e
Subdivision Name Sabd. Lot tl Tax Map Block Lot 1_ Z-
�7 ¢� Renewal Revialon ❑
Owner /Applicant Name /7 ,; �Y / �/ L'' /
Date of Previous Approval
Man Ing Addreos Town ZIP
Building Type v a Lot Area Fill Section Only Depth Volume
Number of Bedrooms Design Flow G P D Ct PCHD Notification is Regal�r'e}d�When Fill Is completed
Separate Sewerage System to consist of �PE V Gallon Septic Tank and 19� 1 sZ % 4 i1 vii - ' "
To be constructed by Address
water Supply: Public Supply From Address
or :Private Supply Drilled by - Address
.. of RE
Other Requirements on aao
t e separate sewage disposal system
1 represent that I am wholly and completely responsible for the design and location Of the pr ,,,
above described will be constructed as shown on the approved amendment there to and in ac da e' ds, ru s an regu a ions o e u nam
County Department of Health, and that on completion thereof a "Certificate of Constru ion fiance" satin %ry t the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, dl33soIs or a o builder, that said builder will
place in good operating condition any part of said sewage disposal system during the ri `� t s im $tliat y following thedate of the issu•
once of the approval of the, Certificate of Construction Compliance of the original sy m 4dny r eto)stheta he drilled well described above
will be located as shown on the approved plan and that said well will be installed in accords t S. rul risgu a ions of the Putnam
County Depa► meet of Health.
' � Signed P.E. R.A.
Date _
�`P od o°
'L—License No '
Address p -
APPROVED FOR CONSTRUCTION: This approval expires two from the date issued unless r agdafha building has been undertaken and Is
revocable for cause or may be amended or modified when Co dered cessary by the mmissioner o 4 sm,. Any change or alteration of construction
requires a neZe rm it, pproved for disposal of dome c Sa wad /or at ter supply only.
Rev. Title {
1/87 Oate By
... . .; ENGINEER M T Pd� Q H��E� ��&E HdH }
�Lll'VJa)l iii "va"L: ^:t�- �+�►>�,i� y„nrires,.CWr»61, iN Y. 90612 PERMIT # /
CERTIFICATE OF CONSTRUCTION COMPLIANCE, FOR SEWAGE DISPOSAL
SYSTEM
J Al ,/ /�,/ /,� ,,/I / q Town or Villa v ,
Located at % Y7 r� f' /� --�' Tax Map _/ Block
Owner elf / Formerly Tax Map Lot U �'.. d� Su)zl. Lot a1 0
Separate Sewerage System built by ' G'Y� �� Address %� .S /�r �� J /�t Wv Ll dL
Consisting of Gal. Septic Tank ands
Other requirements _ _ a`l'•'t'V'!JC/! 4) £4 t 4 �
Water Supply: Public Supply From
Private Supply Drilled By ��% »✓�
Address r ey- !�✓{�j / `t
�r J
Building Type � (�'� �� fdo, of Bedrooms Dote Pfarmi4 Issuod
Has Erosion Control Been Completed? y Has garbage grinder been installed? /d
I certify that the system(s) as listed serving the above premises were constructed assentialLlx as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, Y the filed plan, and the permit issued by the Ti
Putnam County Department Of Health.
Date T Cer ified Dy�a ' P.E. R.A.
Address l� n r/ s I
Llcentva No�/
Any person occupying premises served by the above system(s) shall promptly take
conditions resulting from such usage. Approval of the separate sewerage system
available and the approval of the private water supply shall become null and void
subject to modification or Change when, in the judgment of the ComigHss)oner of
ouro the correction of any unsanitary
AS a public sanitary sower becomes
ten available. Such approvals ore i
ition Or change Is necomry. j
j��•� 1 R -v q0 f����,� Title
By /0
1Reb. 3/V6 Division of Environmental Health Services. Carmel. N.Y. 10512 Engineer to Provide Permit q
on CERTIFICATE OF yE/
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit q (/ 6
Located at '" �G / r t' � JY' 1r Town or Village
Subdivision Name Solid. Lot q Tax Map .43 Bloc_ l t s
�f�i•�... -iL� ; ✓._ �_/cI —. _ .�y :..v.- ►':u -•., :'�CLLbNrYj:- �r,. TM _....._. BtO_.. ... : U -�1 • .....�..- ' -�rt•-a • .. a ii :.;n.:: .
_.. .....__ _ . .. ,., �• / lO/� L'�!r / // ��j� .: Ir+ v.. . eVI
fIn .:.
Owner /Applicant Name
Date of Previous Approval • A �P'
Mailing Address F% Town /his' At, aAZ yip 4. S% p
r
Banding Type / 7 "S' Lot Area Z 3 m P P FIII Section Only Depth -Volume
Number of Bedrooms Design Flow G /P /I) ��%O PCHD Notification is Required" When Fill le compLleted
Separate Sewerage System to consist of Galion Septic Tank and
To be constructed by Address
Water SaPPI)'. Pdbnc Supply From Address
or:---L-Private Supply Drilled by - Address
Other Requirements
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and intoaaaroWM�,th the standartls, rules an regu a ions o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Cod 106 � l e" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the,OWvr>($k\, hia�yr��rs s or assigns by the builder, that said builder will
Place in good operating condition any part of said sewage disposal system dVrngNha °pU"IW g rs Immediately following the date of the issu-
ante of the approval of the Certificate of Construction Compliance of the a{iglnalli4t m or a y s t ereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be InstallLed, ink} acs ' ante with th t nda rules and regu a ons of the Putnam
County Depar ment of Health.
Date I&V I O O S Signed `y <a °i.',. -4 P. E. v R.A.
zz
_
d'
Address G� -r" �s • ° License No
APPROVED FOR CONSTRUCTION: Th' approval expires one year from the da(es,,Tisu4P u s i nstrJe,44 of the building has been undertaken and Is
revocable for cause or may be amended r modified when considered necessary by tt)e`t;o dotter ai h. Any change or alteration of construction
requires /aa new permit. QApproved for disposal of domestic Hilary sew e; am iVat}(ev�avtgo.ur�� O -Only. /�_tI_
Date r —2 5 �(' �ri BY �' rM It K4ea�l'' Title rl
PUTNAM COUNTY DEPARTMENT OF HEALTH ,
.ev. 3186 ` ��� Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit q
\\ on CERTIFICATE OF COMPLIANCE�i/
CONSTRUCTION PERMIT FOR S A E DISPOSAL SYSTEM. / Permit q l/ fffjjj D
xo.,u_.cr --iianas
Subdivision Name' - •~ Vcabd. Lot q� Tar Map Block �Lotr r
Renewal_ Revision
Owner / Appncant Name / �7— !/a C,/
Date of Previous Approval '��f
Mailing Address • Town Zip r
. .<0
Building Types , Lot Area
Number of Bedrooms Design Flow G /P /D °49 0
Separate Sewerage System to consist of Garton Septic Tank and `a
To be constructed by Address
Water Supply: , Public Supply Fro m Address
or: Drilled by Add.,m
Fill Section Only U Depth Vohnme
PCHD Notification is Required When.Flll is completed
Other Requirements ___P.
I represent that I am wholly and completely responsible for the design and location of the proposed
above described will be constructed as shown on the approved amendment there to and in ce
County Department of Health, and that on completion thereof a "Certificate of ug�On
be submitted to the Department, and a written guarantee will be furnished t ;
place in good operating condition any part of said sewage disposal system r
ante of the approval of the Certificate of Construction Compliance of th rigi s q
will be located as shown on the approved plan and that said well will be install in dance witMq
County Department of Health,
`.'
0 Date Signed
V49 X l e 1-111vollpol '
a A
APPROVED FOR CONSTRUCTION:/Orhis approval expires one year from t1* 8l.e ijued
revocable for cause or may be amended or modified when considered necessark%; 4; a for
requires aMn�ew pe mit. Approved for disposal of domestic sanitary sewage,°I:d
Date By
any;
u W� /,
system(s); 1) that the separate sewage disposal system
with the standards. rules and regulations of e Putnam
liance" satisfactory to the Commissioner of Health will
so heirs or assigns by the builder, that said builder will
t (years Immediately following the date of the issu-
y thereto; 2) that the drilled well described above.
``stn ar rules and regu a�TFions of the Putnam
I 1 P.E. - A.A. _
License No
on n of the building has been undertaken and is
.6 °44>•~n Ith. Any change or alteration of construction
�z
`����� PUT NAM DEPARTMENT H' O]E HEALTH
VJ
HPermit
Division of Environments/ Health Services, Carrn% N. 10512
CONSTRULTtORI PERMIT FOR SE
NUAGE .DISPOSAL SYSTEM -�
LOtete6 ' jot
- r F'�..'Io!. -"..- • .�'�'�'% �i � _ -
Tax Map Block '— Lot' E`
Ste' Lot
Subdivision Renewal Revision
Owner /Address d o ' �
Date Of Previous Approval
Buildih g Type
T /g vPs=� °�i1 Odo f J
Lot Area Fill section Only ❑
Number of Bedrooms Design Flow G /e /D 1 4. y d
p P.C. H. D. Notification Required
Separate Sewerage System to consist of 7 ®0 Je I
Gal. Septic Tank and '��� � :� i� �%� °?
r 8'�9 :: '
To be constructed by '�
Address
Water Supply: Public Supply From
_lam" Private Supply to be drilled by
Address's j
Other Requirements
I represent that I am wholly andeompletely "responsible for the design and location of the
above described will be constructed as shown''onrthe a proposed system(s); 1) that the separate sewage disposal system
approved amendment there to and in accordance with the standards, rules an regu a ons o e u nam' {
County Department of ,Health, and that_on'completion thereof a 'Certificate of Construct�.�gpq® ce•• satisfactory to the Commissioner of Health will
be submitted to the Department' and a' written guarantee will be furnished the owner beWICe"
place in good operating con dttton' any part of _said sewage disposal' system during �Rpe�`►t, 0 "" k') or assigns by the builder, that said builder will i
ante of t1 approval of the, C&tiiicate of Construction Compliance of the origin s coq °B 4 (`U rs immediately following the date of the issu-
will be located as shown on she: approved plan and that said well will be install n a ord a °;thh`�e�{ �eto; 2) that the drilled well described above
County Oep ` ment of Health e
�(tz o f)Qardryt" rules and regu a ons of the Putnam
rl% sue% 4f
Date _ �� �', � " ° ,
Signed r d
/ �,� G'� a P.E. R.A. 1
Address ' rr/► C'Ad� ° a�,, op
� r Ali. ° License No.
APPROVED FOR CONSTRUCTION: This ' approval expires one year from the date ? "
revocable.tor cause or may be amended")
modified when co Bred ecessar b th ss%conw °ttof) df the building has been undertaken and is j
requires a ew permit. A Y y t to r�i�foH81h% Any change or alteration of construction
PproveG;'for disposal of domestic sa ita7. sews and/
PRIY °,:Onnly.
Date ° '° ;. sj,ra.•
By
e _ -
Rev. 9 -91 Title
.. ?
'P ermit tl --'-
PUTN Ali COUNTY DEPAYt'I'i�iEN'II' OF ][�IEAIl."�l0
\� r Services, Carmel, N. Y. 10512
y _ ision of Envirnnmenial Health Se
Town or lage r
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Block %J Lot
J�'9!� li Tax Map
(jam Revision _ ❑
Located at Subd Lot II Renewal —1�'�- ,
Subdivision Date Of Previous Approve,
Owner /Address I i Fill Section Only C3
Lot Area /� J I
Building Type 4 �� P.C. H. D.aotificati3n Required IJ—
Design Flow G/P /D ..� L�7d 6° - - -� -1�
Number of Bedrooms _�— Gal. Septic Tank and
I
Separate Sewerage System to consist of Address
To be constructed by i
Water Supply: Public Supply From
Private Supply to be drilled by
Address
Other Requirements ] that the separate sewage dis oe I system
Rance" satisfactory to the Commissioner of Healthwill
roved amendment there to and in accordance with the standards, rules an regu a TO o
1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(" l he builder. that said builder Wlll
completion thereof a "Certificate of Construction Comb � het 1qjtj0►'a
above described will be constructed as thatwon comPapD ir5
County Department of Health. rtod of two y� i edirt=s�1%!ollowln9 thedato.o4 the lssii•
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, �jaet th$ drilled well described above
part of said sewage disposal system during the pe ' r i� �t�:.,
place in good operating condition any Da s'46 add regU a ons o4 the Putnam: J
ante of the approval of the Certificate of. Construction Compliance of the original system w any a ( }!
will be located as oval on the approved plan and that said well will be installed in accordance with th
®
ealth. . . ?�
r +r'' ` PE R.A. ' {
County Department of H f
Signed
fdo. N�-
Date
Address c�j 1 ti9r? 04 the buildlh9 has been undertaken and is
° Ifh:, Ar1Y' change ;or.' alteration o4 construction
APPROVED FOR CONSTRUCTION: This approval expires one year from the date the C d missio ► $��„a•�;: N,
z
wage. d/ ► r vats er
revocable for cause or may be o amended disposal 'of domes
revocable by o f say. y�e ±
requires a new permit. App Titl®
�T By
nff0
1 ?-.:
4-
WLLL UUrLrLL11UV rlzruzu
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
TUWNLAWrAUcl1q, TAX GRID NUMBER:
OWNER
WELL 0 RI
"AM ADDRESS:
.
V ATE
p "BLI PUBLIC
USE OF WELL
1- prlmary.:.
2 - secondary
RESIDENTIAL , AL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED
BUSINESS 0 FARM 0 TEST/ OBSERVATION 0 OTHER (specify)
0 INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT gpm.INO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
CK NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION
0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
;DEPTH OATH
WELL DEPTH .ft
C WATER 'LEVEL ft. ,
L DAT. E 'MEASURED: 1 7
DRILLING
EQUIPMENT
`ROTARY 0 COMPRESSED AIR PERCUSSION ODUG
0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify):
-WLrLL-TY.PE_-
-0., .0 OPEN END CASING 0 OPEN HOLE, IN BEDROCK 0 OTHER.
TOTAL LENGTH tL MATERIALS: 5S TEEL .0 PCkSrtC:C UTH-R
CASING
DETAILS -
LENGTH.BELOW GRADE ft.
JOINTS: 0 WELDED aTHREADED 0 OTHER
—DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE THER
WEIGHT PER FOOT A Ib./ft.
DRIVE SHOEjaYES ONO I LINER: C3YES)9VO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH To SCREEN (it)
DEVELOPED?
FIRST
0 YES. ONO
HOURS
SECOND
GRAVEL PACK
0 YES
owe
GRAVEL
I SIZE
DIAMETER'
OF PACK in.
TOP
DEPTH -ft.
BOTTOM
OEM - It.
WELL YIELD TEST 1, If detailed pumping
METHOD: 0 PUMPED i tests were done is in-
.''OMPgESSE AIR formation attached ?
0 BAILED C3 OTHER 0 YES 0 NO
It more detailed formation descriptions or sieve analyses
WELL. LOG'. are available, please attach.
DEPTH FROM
SURFACE
Water
Pear-
ing
well
Dia-
meter
FORMATION DESCRIPTION
COOE
WE.0burk
'-'bifllfth
hr. -min.
'O:R&06WN
It.
9Pm_
Surface
d(
-4
-----------
WATER '0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES ONO
STORAGE TANK: -TYPE
GAL.
WELL DRILLEWNAME
/10_?Z6 x4i
,V�/Jxx,
ADD, 11" . SlGfnMRE
cq�' #1
ilil
TYPE ' CAPACITY
MAKER DEPTH
MODEL VOLTAGE — HP
01
r� ®w� Medial -I� ®rat ®ry$ F` Y h 4 • 3 o ®� ��s f f r t
�'.. JX' k e �'. i 7 � '�� K".✓' ,. b t 1 ' -:f 4 � i!T
321' Rw stsM a F ; d .: 2'� < sa -tfip 1�h7 ev�� .:.W ( SP al ® a <P ^Y �•,.
ry �f�keoaane Heeghcs, Ac ° d:
(914) 245 -3203
' -� Date, Eepo�ted: °AN.= 291988 '
ect� Albeat �l: PadovantAL T. 4SO
i 1 Coblected Dy:
USge
®ape ®aa$ioao
c
7
"Ph ®ne
Sample Type:
�ifIYi 165P70 Repeat Test?-,- ( check one)
LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
. Standard Plate -Count (CFU /1.OmL) 33 0
(Agar Plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
lore Co'lifotm I F0 %100mL) ', =
Fecal Coliform (CFU /100mL)
` Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
- o
_ Total Coli-form: MPN Index (per 100mL)
Fecal Coliform: MPN Index (per 100mL.)
OTHER ANALYSES
REMARKS (For,Laboratory Use)
_,/Potable
Non- potable
_ STP INF
STP . EFF.
® Other:
Sample Status:
(check each)
Outgoing -- _
® Na2S203
Incoming
_6.�E 4 ° C
GT 4 °C
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source.
TNTC= Too Numerous To Count
CON = Confluent ( =.TNTC)
LE a Less Than or Equal to
GT ' = Greater Than
N/A =.Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE 01WAS) (WASN'T.) (N/A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH ORK STATE DRINKING
MATER STANDARDS, FOR THE PARAMETERS TESTED9 AIME OF COLLECTION.
M_
.Lab Use Only:
PffNAM COUNIY DEPAR(IMENr OF HEALTH
DIVISION OF E:NVIRONhiP: ML HEPLUM SERVICES
Owner or Purchaser of Building
Building Constructed b�y
!/! Gq.,-- �9vYrGL°
Location - Street
riunicipality
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee.to the owner, his successors, 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 approval of the
"Certificate of Construction Compliance" for 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 occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the 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 of /., G 1912
General Contractor (Owner) - Signature
A
Signature'-
Title
Corporation Name (if Corp.)
Corporation . Name (if Corp.)
/`7 1 e Address OS��
....Ada�ess - ... . _ _ ! ..... .. _ .:.�:...«+ mw>.Wrrr�vr_.Y..: _S:':x�-_v-'�^°_• a��.:".�� c . ..
rev: 9/85
mk
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date IVZ -7
Re: Property of
Located at b�'' ✓� 1,.
(T) ;a /7-"fA17 4jle' Section 5-3 Block Lot _
Subdivision of
Subdv° Lot # Filed Map # Date
Gentlemen:
This letter is to authorize =; •?� %/
- -a duly licensed professional engineer / or registered architect
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
Department of Health, and to sign all necessary papers on my behalf in
connection with this 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 yours,
n
Signed ; ` ,e
%a Owner of roperty
CGpuntersig d• °
°
a
P °E o , S �y �X 'd!ec
'�
,4d dress
JZo
Address �;aa's_sp® Town
F s Telephone
. Telephone
JOSEPH F. SULLIVAN, P.E.
&nuAng F.qbmat
2972 FERNCREST DRIVE
YORKTOWN HEIGHTS, N. Y. 10598
(914) 962-4248
September 23, 1987
Putnam County Health Department
Putnam County Office Building
Department of Environmental Health Services
100 Old Route 6
Carmel, New York 10512
Gentlemen:
Enclosed please find a new co:
3 copies of a Separate Sewage
to be located on Mr. Heller's
in the Town of Putnam Valley,
ns ruc ion per * mit and
Disposal System design
lot on Lakeview Avenue
New York.
From a field inspection, there have been no field
changes at the site to adversely affect the pro-
posed disposal system or the location of the pro-
posed well.
Very truly yours,
Joseph F. Sullivan, P. E.
JFS/ats
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address
Town /Village Cit Tax Grid Number
WELL OWNER
Name
Address
/�;
Qrivate
O Public
USE OF WELL
1 - primary
2 - secondary
gKESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/ COND /HEA PUMP
(3 BUSINESS 0 FARM O TEST /OBSERVATION
® INDUSTRIAL O INSTITUTIONAL O STAND -BY
O ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT` gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE ,' gal
REASON FOR
DRILLING
CKEW SUPPLY
O REPLACE EXISTING
SUPPLY
❑PROVIDE ADDITIONAL SUPPLY
® DEEPEN EXISTING WELL
®TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
RILLED
DRIVEN
®DUG
O
GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING?
F
YES B-10 NO
FIDI iii iJ� Oli j��_ _ ^`p� •r- _ _ - _
Lot No. ::- . —.... - ...._.....,,.
WATER WELL CONTRACTOR: Name /Y /177 d°0j49-107 Address:cs� ®�f/ �p
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO ,
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:����
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
0 ON REAR OF THIS APPLICATION ON SEPARATE SHEET
(date)
0
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and,
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form pro ided by the Putnam County
Health Department.
Date of Issue: O 19 %i
Date of Expi rati on
Permit is Non - Transferrable
Punm COIINTY DEPARUMU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
., _ ..cam'.
FIELD INSPECTION REPORT
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO
Wetlands on /or proximate to property..............
Property lines or corners found ...................
Can estimate house location............. ........
Willdriveway need cut ............................
Must trees be removed - note these ................ �(
Deep holes representative of entire SDS area......
Additional deep holes needed..... .....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics .......... .... ......
101 :
` D.H. - Deep Hole
G.W.- Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G.W. Depth 'to G.W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
0 ft.
3 ft.
6 ft.
• . 9 ft..
12 ft
"O/A
4 Soil Description
�G] 0 ft. 0 ft.
/,0 / v ft. 3 ft.
G _Ppvs 6 ft. ft.
ft. 9 ft.
d / 12 ft. 12 ft.
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded........... ....... ....
10 ft.. maintained fran property line and
20 ft. fran house ..............................
Distance well to SSDS (ft.) ......................
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft.:of peripheral soil horizontally
'li�%.1'�:+G iJiit i °..i '1'Y' .f •;�J..•• _ .. ....a a�'c a. +a -..
Boxesproperly set........ .......... ........
... ...._ __ _._.
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
I
t
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACC:EPTABLE.. ...
PUTNAM COUNTY DEPARI� OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY /SUBSURFACE SEKkGE DISPOSAL SYSTEMS
FIELD INSPECTION REPORT
DATE: ��� -+�
"rt11 �r INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION - p 4 C-d I YESI NO COMMENTS
Wetlands on/or proximate to property .............. (L/
Property lines or corners found ................... e--
Can estimate house location .......................
Will driveway need cut ............................
Must trees be rived - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed...... .. ... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics...... ....... . ......
D.H. - Deep Hole
G.W.- Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G.W. Depth to G.W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
. -- _ � MS�l- -mot
0 ft.
3 ft.
6 ft.
9 ft.
V
12 ft.
0
ft.
3
ft.
6
ft.
9
ft.
12
ft.
0 ft..
3 ft.
6 ft.
9 fto
12 ft.
'Soil Descri
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ............. ... .........
10 ft. maintained fran property line and
20 ft. fran house.... ........................
Distance well to SSDS (ft.) ......................
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
from trench.......... ..... .... ... .. .
..
w :e - �;roperlY -sec e e ". o ........... o ................ ��
_
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
r-
EINAL GRADNG OF SITE AOCEPTABLE...
JOSEPH F. SULLIVAN, P.E.
2972 FERNCREST DRIVE
YORKTOWN HEIGHTS, N. Y. 10598
(914),962-4248
April 901986
Putnam County Health 11ep artment
Ntn'OM.County Office Building
Departm—nt-ef Environik6nt6l Health Service
Carmel N.Y. 10512
Gent,l--6men,,
thelosed please find- a new construc.ti6n.permit for M'. Hell-ers
separatt sewage disposal system to be lbeat6d on his.lot on Lakes
view e in the town of Putnain Valley, I Y.
e r o -have- satin - f I A -ohang
,the site. to'adversely affect the prbpos.6.d dispqs'al'system or the
location of the proposed well,
Very truly yours
Joseph F. Sullivan P.L.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property ofr!�`
Located at ,/'Jf ��/ �1't/ )Y��✓%�.�
(T) Section Block Lot
Subdivision of —'
Subdvo Lot #
Gentlemen:
Filed Map #
Date
This letter is to authorize
a duly licensed professional engineer or registered architect
(Indicate
;,o Hpfjy .Mor a Co;,x±.rwct; nr Parmi.t 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
Department of Health, and to sign all necessary papers on my behalf in
connection with this 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.
Countersigned:
P*Ee, R<Ae, #
2-
Address
Very truly yours,
�p��°p
Si d�C��- -
�m a
a
gn e r� -��-�
Owner
f Property
Address
Town
Telephone �-
.� RECEDED
MAY 1® 1982
Mot. OF HEALTH
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
E iv lILilY4�� viii u'l iL� l� • 1 • � 1V,1�... �. ... - - - . , �. .. s...�l
DESIGN DATA SHEET -SEPARATE /SEWAGE DISPOSAL SYSTEM FILE NO. ,
Owner 117oJ e_ 11"1- �Tze / /i°✓Addressl� Z ��.r,GCC+ �`5�� �,,,�`Ya %��"I
Located at ( Street � l Sec. u'-� Block Lot
�Indicate nearest cross street)
Municipality ? a12-7 N a-Jlle- V Watershed
L PERCOLATION TEST DATA l
TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
)Jr
PERCOLATION
Elapse
Depth to Water
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
2 M:2.5-- AG/ A2
�U
/
3 2r_
4
1 /l 6:;,a /O
7i
5
1
2
3 RECEIVED
• A44V 4 A z
CE . l,,,ylvl c.vUNTY
PT, Of HEALTH
Notes: 1) TpAts to be repeated at same depth until approximatelyy 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.
)Jr
Ag
5
1
2
3 RECEIVED
• A44V 4 A z
CE . l,,,ylvl c.vUNTY
PT, Of HEALTH
Notes: 1) TpAts to be repeated at same depth until approximatelyy 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.
DLi lTii
G.L.
6►►
12'►
181►
2411
3011
3611
4211
4811
5411 ..
6011
6611
7211
7811
8411
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HI)LE NO: -. -HOLE au_. '.
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED i
INDICATE .LEVEL TQ.XIICH WATER . LEVEL RI "e( ES_ AFTER _ENCOUNTERED
` 57
T
T''�TS 'yYfir�� Y" _
DESIGN
Soil Rate Used Y Min/1 "Drop: S.D. Usable Area Provided ;5r�C?O
No. of Bedrooms :3 Septic Tank Capacity �42 Gals. Type O.ta r 1
Absorption Area Provided By,3el, Ci L.F.x24" width trench.
Other
Name bignature pougc °ate
r�
Address '2: 1.7 %-- `ice /i'' ,�i': L CAS°° a�
THIS SPACE FOR USE BY HEALTH DEPARTMEN ONLY:'' rI
F' 0. 04
is
Soil .Rate, Approved Sq. Ft /Gal. Checked by
VF