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BOX 25
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03070
Sac
USA �C 2 ( I Z °j tN161 NttK''MUS
�` PUTNAM COUNTY DEPAR'TMEN'T' OF,•,HEALTH
PROVIDE
1 ` L Division of. Environments/. Ailth- Sertnoes, Germ% N: 'Y 1051? PERM --
IT
,2,
CERT ICATE TOF CONSTRUCTIOW IC' LIANCE .FOR; SEWAGE DISPOSAL ` SYSTEIN
`' Town or Village
• .Located at Oil Tax�Map -�: UJI
/�i L LIE $ T ' .SWA /�IsO� ` b' /Formerly Tax .kap iot' a s 7 �' subs. roe a /.SS - 171
Owner Separate Sewerage system built by , (^�E RT SIJAn1S0� _ Address OnJaH I[ oft f1t L k
Conslsting of 00 G—al.'Septic Tank and
S p:0, L.F Or-.: .FT. .In%s D E R'F 1 C E;S N'. Y. J 0174
Other requirements ..
Water Supply- Public Supply From
Private Supply Drilled By* i1ldaMAA) ' Ny�� CSon!
Address E T — w L .1n Q s"
Building Type OAI E FAi4Z L Y R F-5. No. 'of, Bedioom$L Date •PSrmit Issued
Has Erosion Control Been Completed? Yes Has garbage grinder bee .. nstalled7
I certify that the systems) as listed serving the above premises, were constructed essential%a�i'hc�n,on the plans of the completed work (.copies
of which are attached), and in.accordance with the standards, rules an lations, in accothe filed pia and the'peruit'iaeued by, the
Putnam County Departinegt•Of Health.
_oZ Certified by V
Oats P.E. R.A._1S_
6
Address O DT ." . on N . %j L. . N. O.r I .Lice se No: 1 L 4 S
Any ,person occupying premises served by "the above systems) shall promp ly t e such actio`` s may be necessary to secure the c rrectlori of any unsanitary
conditions resulting from *such usage. Approval 'of. the separate sevvera em shall b me nultind void as soon:its a pu Iq sanitary ewer becomes
available and the approval of the private. water'. supply shall become null and void when putiik: 'water supply becomes available. Such approvals are
subject to modification or change When in' the judgment of the Commissioner;of Hdalth, such revocation,,modification or change is necessary.
Dater
Rev. 6/85
m
BY
Title
11!
67 r I
. _ A
61
Wz1j1j L0Vr1.Cijr1.Lj_VL1q Office Use Only
DEPARTMENT OF HEALTH
ivision- of. Environmental. Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
P
'STREE DURESS: VILLA 'TAX GRID NUMEIER:
WELL LOCATION
e.�>
�
WELL OWNER
NA ADDRESS: /
�F
I d PS'IVATE
0 PUBLIC
USE OF WELL
fi(RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP ❑ ABANDONED
1- primary
❑ BUSINESS ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify)
2 - secondary
C3 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑
MOUNT OF USE
YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE ?(!� gal.
REASON FOR
29 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION
DRILLING
'OSEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.1
STATIC WATER LEVEL --2 —ft.
DATE MEASURED
DRILLING
`ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft
MATERIALS: %STEEL - 0 PLASTIC. ❑ OTHER
CASING
LENGTH.BELOW GRADE
JOINTS: ❑ WELDED ❑ THREADED 0 OTHER
DETAILS
—DIAMETER in.
SEAL: ❑ CEMENT GROUT 0 BENTONITE ❑ OTHER
WEIGHT PER FOOT lb./ft.
DRIVE SHOE 0 YES 0 NO
LINER: OYES ❑ NO
SCREEN
DIAMETER (in)
I
'SLOT SIZE LENGTH
(ft)
DEPTH TO SCREEN (It)
DEVELOPED?
FIRST
-
❑ YES ONO
DETAILS---.
GRAVEL PACK
❑ YES
GRAVEL DIAMETER
TOP
BOTTOM
❑ NO
SIZE OF PACK in.
DEPTH ft:
OEM - it.
WELL YIELD TEST I If detailed pumping
11
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach.
W
METHOD: 0 PUMPED tests were done is in-
OMPRESSED AIR formation attached?
A
DEPTH FROM
SURFACE
SURFACE
Water
gear.
Well
Dia-
0 BAILlfO, 0 OTHER OYES ONO
ing
M ter
Ile
FORMATION DESCRIPTION
CODE
I
WELL DEPTH
DURATION
DRAWOOWN
YIELD
Surface
It.
hr. min.
It.
9Pm_
WATER 0 CLEAR
TEMP.
QUALITY ❑ CLOUDY
HARDNESS
O,COLORED ANALYZED? 0 YES 0 NO
ANALYSIS ATTACHED? 0 YES ❑ NO
STORAGE TYPE
CAPACITY RAL. j
PUMP INFORMAT[ON
TYPE 42�
o,,
CAPACITY Is
WELL DRIUA NAME %���eoo'
V AJ�
MAKER a
DEPTH
MODEL
VOLTAGE �t Ii
_)Ao
t�ADORE
67 r I
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61
a
rktowrn Medical Laboratory, Ins.
321 Kear Street
_.. Yorktown Heights, N. Y. 10598
Director: Albert H. Padovani M. T. (ASCP)
T-
L
J
LAB 1 87.0 678
Date Taken: 2- l��d' Time: �
.Date ..Rlc!d:_ _ _ Times �•� fn
Collected By: �• �'1t,� /J��
Referred By:
.Sample Location:
Phone I J -�
Phone I Sample Type:
Repeat Test? (check one)
LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
4 Standard Plate Count (CFU /l.OmL)
(Agar Plate 8 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
V Total Coliform (CFU /100mL)
Fecal-.Coliform (CFU /100mL)
_ Fecal Streptococcus (CFU /100mL)
MOST PROBABLE - NUMBER TECHNIQUE (MPN)
_ Total Coliform: MPN IndeX (per 100mL)
Fecal Coliform: MPN Index (per 100MO
OTHER ANALYSES
V
J
�otable
_ Non- potable
_ STP INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
_ Na2S203.
Incoming
VLE 4 ° C
GT 4 °C
Other:
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
REMARKS (For Laboratory Use) CON = Confluent ( -TNTC)
LT = Less Than (C)
r GT = Greater Than (>)
Al .� --IN /A = Not Applicable
Cl �t Less than or equal to
1. -
THESE RESULTS INDICATE THAT THE WATER SAMPLE 'jWAS) ,/(WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THkI,11-EVF YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT'THE TIME OF COLLECTION.
Albert H. Padorani, M.T. (ASCPj, Director
.2 /85(RY3'd7 /87)RWE
For Lab Use Only:
_ H/C to
LAB OFFICE HOURS (Hain Lab)..s
9AM -5PM, Mon. -Fri.
9AM -ROOK, Sat.
3
=0
JOEL LAWRENCE GREENBERG
bArrhitect ® Town Planner
Mus000t North a RFD #2 o Box 488
MAHOPAC, NEW YORK 10541
(924) 628 -6513 _ 19141 526.3740
U'oWn Manner o Putnarn Valley, Nt
TO Putnam County Health Department
Carmel, NY
ELEETTEa ors UIMaRZOMDU L
DATE- '� --
JOB NO.
5 -85 -198
_1/12/89
ATTENTION Bi 1 i Hedges `
RE: Mr. & Mrs. Albert Swanson
SSDS As -Built Plan
~t ruct ion com liance for Sewaa e
> WE ARE SENDING YOU ached ❑ Under separate cover via the following items:
• Shop drawings U_Pdrff's ans ❑ Samples ❑ Specifications
• Copy of letter ❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION
~t ruct ion com liance for Sewaa e
Disposal System.,
Laboratory Report
3
Guarantee of Separate Sewage System
Sewage DisXlosal System Plan
THESE ARE TRANSMITTED as checked below:
r approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE 19
REMARKS
• Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
}
r 6
ALBERT SWANSON
Owrier or Purchaser of Building
32
Section
Building Constructed by Block
WENONAH ROAD
Location - Street .
TOWN OF PUTNAM VALLEY
Municipality
5, 6, 7 & 8
Lot
LAKE OSCAWANA EAST # 1
Subdivision Name
nNF Ferr r LY. RER1 DENCE
Building Type Subdv. o
GUARANTEE 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 guarantee to the owner, his success-
ors, 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.._ cone lus1ve -thP. de.terwi.Dr,
eo, -cam -of •t 'Divis or u ° EriJ'1rUIlmenLai tfealttl- Services . • �I
of the Putnam County Department of Health as to whether or not the fail-
ure of the system to operate was caused by the willful or negli ent act
of the occupant of the building utilizing the system.
Dated this 23rd day of NOV. 1998 Signature_•• i
Title OWNER & CONTRACTOR
WENONAH ROAD
PUTNAM VALLEY, NY 10579
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
f
3
MAL SIT9 INSPECTION Date
Ins-ad by
j,OCATION C f
t - b ., ; 1 �� , ' :.• = > ... k 1i `i 'lO 061, l ICN LOT
SA
i
I'.
a
1•�
IV.
V'•
Scy[�CE DISP01, AREA
d. SDS dre3 1ocated ds aDDroVed any
'"
151
YES
NC(
� CC�.Q�Y
.
b.
Fill section - Date of place-Tent 11
2:1 barrier. LGTH W� H AVG.D
�-�
c.
Natural soil not stri
I
I.-
d.
Stone, brim, etc., greater than 13' f_ar, SDS are:--.
e.
100 ft_ fran water course/wet—lands.,,
SD.vtC✓ DISPOSAr, SYSTE1
a. SeDtic tacit size - 1,000 1,250
`
h.
Seotic tarn_-, installed level
I
c.
10' minimLm from foundation
d.
No 90° bends, cleaneut within 10 fn. cf 45" bend
e.
DISTPIBLTICN WA
1. A11 out-,e--s at same ele,, ti Cn - •.vate_r teS t-..1'
f
2- Protec te--; below frost
l
l
3. Minim -mi 2 ft. oriainall soil ber,;e--n bcx acid tre_ncies
f .
J'UNCT'ION ECX - prouerly sei-
c .
U ' —s r
1. LiFan&n re-cuirad L__ct^ ir•� -;. 11 %U
I
2. Distance tc wa-tar m =. s-a _ e^ f =.
3. ac--crdinc to plan
I
4. DistGnc= cs -,itcr to c`ntar
5. Slone cf t_e_ncn accept -=le 1/16 - 1/32
6. 10 feet—f=an prccertr lire - 20 ie=_ - fcunca -ions
I
I
7. Depth c_ t_e_ncn < 30 inches fran s-urface
I
I
8. Roan allowed for eYDansicn, 50%
I
I
9. Size cf cravel 3/4 - 1_" diameter
I
10. DeDtn cf c avel in trench 12" minka -am
A.-
_._._
1 Pine Erb S4"'DDe1
._ -1
.
1. Size of DL"'1ID chamber
2. G`vex -f l cq t-=rik
I
I
3 A1ammi, visual /audio
I
I
I
4 PLnD e?S?lV aCCesslble manhole to c=?C_e
I
I
3. First bac baffled
6. Cvcle w_L_nessed by Hea I Ln Der;a ,-renL
I
I
eStllild -- ficw r cycle
I
_. �:CLLe 1CC t orr aoprCVc'.:.' Dlans.
_.
N'l7Le= of b =.—Ca s
I
I
I
b.
Dist =r.Ce f`an s7-- ' _ -_- ;I= _:S'�IrE^' __
C.
Casino 18" abcvec: =ce
I
d.
Surface dra n -ace ar un we! 1 dCCeDL =C__
I
I
I
C'TERAT•I, Vn RMS = _P
a. Ecxes rcce= =v crCUzec
E.
A11 Dices lied
(
I
c.
A11 Dines flush with inside of bcx
d.
Eackfill mGte_riG ccntains stones < 4" in dlZreter
I
I
e_
Cartain drain installed accordinc to darn
--�
f .
Curtain drain cut =all roter-ted & di r. to Exi s t_watercours�._L
I
c.
Fcotin drains cisc-iarge awav fran S- S are=.
I
h.
Surface water Drcte lion ade-T,,-.te
I
i.
E_rosion cccnE provicri on slcoes c= ez-te_r L- 15 %.
PUTNAM COUNTY DEPARTMENT OF HEALTH permit a
Division of Environmental Health Services, Carmel, N. Y. 10512
C S RUCTIOPERMIT FOR. SEWAGE DISPOSAL. SYSTEM _._..:.. _.. Putnam Vallev
QN T. - . -PERMIT - - ' i own or ,V
lllage
Located at Wenonah Road Tax Map 3 2 Block 1 Lot 5,6,71&8
Subdivision �R N/� Subd. Lot p Renewal _1 [
Revision _
owner /Address M , • & Mrs. Albert Swansen, Spruce Mt. �e�Of Previous Approval
One Fam.. Res. Put.Val.�T.
Building Type Lot Area � 1 section only ❑
Number of Bedrooms. 4 Design Flow G /P /D 800 P.C. H. D. Notification Required
Separate Sewerage System to consist of 1 ?on Gal. Septic Tank and -- 50OLF of 2ft wide Trenches
To be constructed by Don Heady Address Canopus Hollow Rd, Put. 'Val. , NY
10579
Water Supply: Public Supply From
XXX Private Supply to be drilled by Norman Anderson
Address Barger Street, Putnam Valley, NY 10579
Other Requirements
I represent that 1 am wholly and completely responsible for the design and locLacrda
above described will be constructed as shown on the approved amendment ther
County Department of Health, and that on completion thereof a "Certificatc
be submitted to the Department, and a written guarantee will be furnishei
h
place in good operating condition any part of said sewage disposal systeonce
of the approval of the Certificate of Construction Compliance of the
will be located as shown on the approved plan and that said well will be installeli
County Department of Health.
6/24/85
Date Signed
rlaarau+
APPROVED FOR CONSTRUCTION: This approval expires one year from he ate issue un
revocable for cause or may be amended or modified when considered necessa y the I
requires a new permit. A proved for disposal of dome c ni ary sewage, and /or riv
Date^' gy
Rev. 9 -81
a)• that the separate sewage dis o"I system
ith rds, rules an regulations o e Putnam
liancl ctory to the Commissioner of Healthwill
heI igns by the builder, that sold builder will
e rs mediately following thedate of the issu-
irs t , e ; 2) that the drilled well described above
and s rules and regulations of the Putnam
XXX
P.E. R.A.
10 4 License No. 11056
is construction of the uilding has been undertaken and is
oner of Health. Any change o s ation of construction
ft--) supply only.
01:� Title
PUTNAH. COLN TY D EPAR'T%. MX T OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Res Property of Mr. & Mrs. Albert Swansen
Located at Wenonah Road
('T) 32 Section - -- Bloch- 1 L ®t 5,6,7 &8
Subdivision of
Subdv, Lot # Filed May Date
o.
Gentlemen:
This letter is to authorize Joel L, Greenberg
a duly licensed professional engineer or registered. architectxx
(Indicate
to.apply for a Construction Permit for a separate.sewag.e 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
-�- � �_ ;'�.,v> _.�:._ �.. -_ : _� ;`.,__ :.:-:� .. -..: - :•: �.... _� _��...__ e.�.:- ,;;..rte -: -� � �'...�. � "�::. r:...- .::.-�.�:.. °:a . _...o-- :�: -�. :�_: _:.�._.:..,. -... _
147,
Education Law, t BRED ,4R c Health L,aw, . and the Putnam County Sani-
tary Code. �vNCO
Countersigned.
P. E. , R - A. , • 1 056
E
A Very truly yours,
Signed
50
fV E `N
Muscoot No..RFD #2,Bx 488
Address
Mahopac,NY 10541
628 -6613 '
Telephone
ner of,� Property
ruce Mtn, Drive
Address
Putnam Valley,NY 10579
Town
528 -9155
Telephone
PUTNAM COUNTY DEPARTMENT OF IMALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- 4". .w __-,.c •'+9m�wa.._�:+i••Rr maw. .- .ae.."�."rnl. T•�sr 'wr6 >•wa+•.vFe�z.lrlr :a�aw.: ..a W :....
COUNP3`C°C 'Y(:E BUILDING, �CARMEL, N. Y. ° 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSJM SYSTEM FILE NO.
Owner Mrz WPs Ai eet'S�ANS�N AddressSPr�ucE MTk. 2v.. i'ct'rNAM L&-,:L�y N•Y 10570
Located at (Street WQ�•
Cw, AN ' • y,' Sec. ' 32 Block I Lot S,• 6, 7 4$
nearee cross street)
Municipality::, — o I uT •� i�� Watershed
:..SOIL PERCOLATION TEST DATA REQUIRED -TO BE SUBMITTED WITH'APFLICATIONS
oe
Number :_....CLOCK..TIME PERCOLATION PERCOLATION
Run Depth to a er 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
.. PTH #1 -1...9:45' "� 10:15 30 •15 17.•75 2.75 30/2.75 =11
2....10 :19• 10:49 30 15 • 17.75 , .2.75 30/2.75 =11
•3 10:5.3 - 11:23 .30. 15 17'_ 75 2.7'S 3022.75 =11
4
PTH #2 ' .1..9'.: 50 . - 10 : 20 30 16 1. 9. 3 '30Z3=10
_ _ _ - _ __�..._ r .w .�. n .' T�,w - � .,,�sr °_r ... �.� w• •M �..•v: Tan•�.T,�_.. .,::�- P:�'.. ��.._Jr r..+a. -.. �aw�
:•_,�_i,n. s�
11:.22 30_16 18.75 2,35 • 30/2..75 =11
Notes: 1) TeAts to. be• repeated; at same
rates are obtained-At each percplation
for review.
Depth measurements to be'made
depth until approximately equal soil
test hole. All data to be submitted
from. top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH �r HOLE N0 . _D P HOLE NO., �HOLE�IVO.
G.L.
6"
12" _ ..
181 .
24"
30"
3611
4211
4811
60"
66"
7211
7811
84
INDICATE LEVEL AT 1!H[CH GROUND WATER IS ENCOUNTERED
? � 'E`- I'L L: TO WN CTW,,WkTE -g : ti .vPtTSE :FTEI? ;BT'.T�fGr.FNCO TB J�- ►�i o .. :`.:. -
TESTS MADE BY - a � � C, 2.E � � a E l2.G Date 6 h,3?19 5 DFSIGV
Soil Rate Used - /,,,�MirVl "Drop: S.D. Usable Area Provided A o o a 51=
No. of Bedrooms Septic Tank Capacit 120 el Gals. T CoNc..
Absorption Area Provided By !oo L. Fex24" 36"-
.
ToP Soil,
SAND, 15-TONE-5, CGLAY
ivame biL64 ,C6 t., .
Joel Greenberg- Architect it
Muscoot RFO.N2 /Bx 488 Nw
Address Mahopac, NY 10541 $
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by,
c
i
0110,D_ 0
O \NEW
Date
s
\D
• N y
r �
19 l
14 22
N \V�
_ 5 E'PT lC _TANK.
X 5 1 2 °' 27 1-4 .
a9ro
�1
1,
Q �
� � t
i
� / r
Ail
_ ..::LO, C_y T_.1_0.:N ,S..
A 8
A
5-EPTI C_ TANK
51'-6 27'
LOCATION
83'V
-#Z
49 43'
"15 901".
ft3
d4° 10" 47 =C;
3i t.4 ' _8$' d9'
_ *4
ALV 52=2"
59'
-
zy6
38' 57' 3"
mat, .. 84' 9A'
6
36,-Y'. (2'- 4"
8 4' 97 -4'
��
34 =3" ��•_Su
mfg '83=)'• loo -ro.,
6
9., 72',r
83 =8° to4_gl,
73' -4
65' 9'. lo8'-m''
i0
35 Li" *85' -d"
1
N
38' -3.. s9'-6"
AZ2 (v7' )64'
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