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03189
i
•,� rr f PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Cerro% N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PQTNAM VALL.
Town or Village
. _.... . '• y tea.. :...: - ., V_.
r
Located at lyV�< U f Taz riap ::% v dock "e--
Owner M GZ ' � P%A� tIL CA410 j�j�i Tax yap �t 11 subd,.,# f%
Separate Sewerage System built by A k -MY— SONS � r' v Address E WXt 014 DD, " • ' VALaV
Consisting of /&M Gal. Septic Tank and _ y L O . WY4E 72,rV r
Other re
gyirements
Water Supply:
Building Type
Public Supply From
Private Supply Drilled By
i. A_ _
Has Erosion Control Been
I certify that the system(s) as listed serving the above premises were constructed
of which are Attached), and in accordance with the standards, rules and regulations
Putnam County Department Of Health. .
Date 61 & &/0
Any person o44cupying promises served by the above system(s) shall prompSW take such action al-
conditions resulting from such uupe. Approval of the separate sewerage system shall become
Available and the approval of the private water supply shall become null and void when a publl
subject to modification or change when, 'in the judgment of the Com ssio r t Health, c
r
Date By
in
of the completed work ( copies
n, and the permit issued by the
:6re the correction of any unsanitary
as a public sanitary sewer becomes
tes available. Such approvals are
lion or change is necessary.
91"49,700" WORT PUTNAM PQ.UNTV PgPA
COUNTY OFFIC9 PUIL.PINQ C.AjRMqL,, Wgj
This ropon -.10 to 00 rQmqlP,,W,.4y-w a
well -driller .-pd- submitted miAnty Hq�l -,ngb qqp.cn
V-14*f 4i- j4djaq-tiho W 4tdr is o satIs fiac t
0 -6i- c anl cpality before certificate
of construption 5* p
im" Iq low,
REPORT * MUST . 0 . E I SU I RM ITTED W . ITHIN . 30 DAYS OF WELL COMPLETION'
77
LOCATION
cm ,
pq Wm
4 w Rim1w)
r�
� Va�
9W ,TIC
Punic
L v
IM
BUSINESS
EATAW5 FAR
.WgHT t
A T;
AIR OTHER
INDUSTRIAt _"INQ El
CPNDITIO (OpRcify)
001I.&ING
coulpt9m
r��MPQESSED CABLE OTHER
AIR PERCUSS101,4 PIRCUS5iON 11
CASING
IP(WA 04
1.4"PT" 1190
R3
DIAWT A(Inches)
welp"T PE
110"T
�7(Tj
2 T P 11 wqw0p
WADI!
YR4 140"
WASGA*
is 117*0
YOULD
A
INQU43 GM
f;;2-
XJ COMPRESSED AIR
ffig4§91t§ 1`110t4 I# —STA Tj 4(qPqQ'fY toot'
Y14LO PEST flop$)
Depth of Comploged Woll
In fgqtWlo.w Land pyrNsot IR
MAC
IF GRAVEL
PACK6Di
P19mator of well Includino 1WAV4
gravol POO (lowhos):
sigo onom
11
pgpm FQ0t9 LAMP OURFACE,
FORMATION DESCRIPTIOM
$kqtCh exact location Of W411 Pith 418007;Q0, I* at (W(
two pormangot 14nomwk0.
FEET to
-L3
---- - -----
It yield Woo 912010d at d191<wnt dppth'
FEET
GALLONS PER MINUTE
L
I/ Z)V 77 7
.77;7kp.�RT
.1w
L . L
rm, , CHILLER ($
---;? - mlbm�z-
YORKTOWN MEDICAL LABORATORY INC.
P :0 BAZ .99P�r •�G9 .a - i6 ..e =.c.v
245 -3203
At AA/44
�_:.,�,. ,. t! . ;S.►i:. .cibilwt 7.:i ": l�Jyb'
DAT C L CTED
.RESULTS OF EXAMINATION OF WATER
OWNER DATE, RECEIVED
PAUL (,ATTrT
CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DAT D
6/13/79
---
•
BACT8RIA PER ML. (Agar plate count at 350C).
COLIFORM. GROUP (Most probable No. /100ml.)
0 MFT
ARDNESS, OTAL = ppm
DETERGENTS - . Mg
NITRATES (as N) - jag L
IRON; TOTAL - Tag T;
A.MI4tjN-Lkk * rxzz t as N w mg/L
These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected.
PER: CROSSROADS PHARMACY , �y
OREGON CORNERS
PUTNAM - VALLEY, NY 10579 A. H. PADOVANI, M. T. (ASCP)
n
Y
R6 PAUL 6&g 1 �Vv� ,o F- FUTNAM L,4ggy
owner or Purchaser o us ding Munic..pa ity
ng < onstruet. ed FY action
a�72& aLe- 0 LJ 12-
Location - Street Block
d� �:AM YZES i��C,
Building ype [ Lo.t
GUARANTY OF SEPARATE SEWAGE SMEM
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 tepairs r,ade by, me to . si.ich system,, except where the failure
to operate properly_is caused by.the willful or negligent.act of the occu-
pant.of the building utilizing. -ttie system..
The undersignad._fur:t_he.r. agre6,s to accept as conclusive the .de
termination of the Director of the. Divi.si:on of En V4 ponmental Health Ser-
vices- of the Putnam County-:De t f` Health as to whether or not the
failure of the system to- operate y4s . :paused by-the willful or negligent
act of the occupant of the 1ai ldl`hg.4� 11z.1ng the system.
c�cl this I L,," day 0.1 19: / �..:signture
Title 0 LA)p C12--
(I corporation, give name,
n a nd dress
-- -- - - - - - - - - - _ - - - - - - - - - - - - - - - 4
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPTTETION WILL BE .,ISSUED .
GUARANTOR IS REQUIRED TO FIDE NQTICF OF P ATE OF FIRST USE OF SYSTEM.
- --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -•
Division of Environmental Health Services, Putnam County Department of Health
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, .Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Piit-nam Valley
,7 Town r Village
..;r"..,ae`9C'�'CP.� "`yw�."ar� ��a��� 1��,*,.,'c,;,�- ,?�"m.}le.�- `gr:•,a --- o..,> ,. '. _ . j --: -.:.., .. ' ._....:�asa'��p;<: ?'y` �>� .. ....: �...+.v.:.:�: � r�.- lns= i�.:,�':.e._'.:w...n,..:.o.. "'
Subdivision Gauci Lot 2.11 Job77 -147
Owner Paiil C WIC-13 Address 1.715 Wallace Ave.
Building Type 1 family house Lot Area 1.9431 acres Bronx, New York 10462
Number of Bedrooms Design Flow 8 -10 Total Habitable Space 1760 Square Feet
Separate Sewerage System to consist of 1000 Gal. Septic Tank and 334 lin. ft. of 210". wide trench
To be constructed by not selected Address
Water Supply: Public Supply From
* Private Supply to be drilled by
Address
Other Requirements
FLED A
I represent that I am wholly and completely responsible for the design and location of the propo 4 tem(s he t e sop t sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordan wi the s an re lat ions o t e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction C ON ce' o t 'C missioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his succe ei or assigns y t der, that said builder will
place in good operating condition any part of said sewage disposal system during the period of it §>Ir!8 q,l>�9 owing thedate'of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any r it a>t drilled well described above
will be located as shown on the approved plan and that said well will be Installed in accordance with the s 6s, IA& regulations of the Putnam
County Department of Health.
Date April 281 1978 Signed P,E, R.A.
Address t icense No, 11056
APPROVED FOR CONSTRUCTION! This approval expires one yea fro the date issued unless eo ruction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered n ry,by mission of Health. Any change or alteration of c struction
requires a new permit. A rove for disposal of domestic sanitar se and/ r riv a wa
Date By �, ' Title
...._,- .vm.<_n.. ,..._.,..tip .-. ._. _ ., •_ _,.: - .. ... ._ , ..... --c .r.. _. _. .. - ... -.-.. t..cn .». <. .e.��r...- r. -. -._ _ y .. ___i. ..,. ..... - > .Y.s o..... ter..__. -.-.r. ..
Gentlemen:
PUTNAM COUNTY 'DEPARTMEIT OF HEALTH
Date_Z,
1 �2 8 1�9 7 8
Re: Property of
Located at
__UortgrL-Hollow Road
Tax Map -4 .
58 Block 2 Lot 2.11
This letter is to authorize
,T _joel Greenberg
a duly licensed professional engineer or registered architect.
(Indicate).
4-0 for
apply ,
U . . 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—sai.d,
system or systems in conformity with the provisions of Article 145 or.
147,. Education e Public Health Law, and the Putnam County Sani-
-0
fk F -4
tary Cod ,
0
Very truly yours
Signed--�'
Owner ol-7(oper ty
0
C untersi'ned: -171) Wa1.1-ace Ave, Bronx, N.Y. 10462
g Address
P.E., R.A., # 11056
AdR , =sc : got North (seal)
dress
Mallu2paa--New York 10541,
Telephone
212-TA8 -5465
. Telephone.
e
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES..
..COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner pa„l ;aur- Address1715 Wallace Avenue, Bronx, N.Y. 10462
T. M.
Located at I(Street) .Block 2 Lot 2.11
n ica e nearest cross _sE_r_e_eET
Municipality Town of Putnam Valley Watershed Hudson
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
apse Depth E`67-aTer Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
Hole
#1 1 Rol s_8:39 24 15 .18 3 24/3 = 8�
•
5
Hole
#2 - -- l '� _4.4.___�_. _i5 - 1_8...- 3 24/3 = 8
2 R! 41;-q n9 24 15 18 3 24/3 = 8
3g- in_9:34 24 15 18 3 24/3 = 8
4 9: 35 -9:39 24 15 18 3 -' 24/3 = 8
5 - •
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 1 HOLE NO. 2 HOLE N0. 3
6" and & small Stones Sand & small stones Sand & small stone S
12" ^
18" "
24" If if
3011 It If i
3611 If 11
`F2"
48" if
5411
60"
66"
72
78ff
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED - none encountered
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED N /A;:''
TESTS MADE BY Joel Greenbera Date. Apr i 1 2F3, 1978
Soil Rate Used 8- lOMin/1 "Drop: S.D. Usable Area Provided 5, 000 sq. ft.
No. of Bedrooms 3 Septic Tank Capacity 1,000 Gals. TypePre -cast concrete
Absorption Area Provided By 334 L.F.x24" * b" width tr
a Ot Ea b A.,
name Joel Greenberg blgnature
Address RR #8, _Muscoot North SE
Mahopac, New York 10541
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
r L,
, ",
< VAN,
��VIM
REVIEW CHECK SF MET
Meets Std.1.
House plans O.K.
Design data sheet
Peres presoaked?
1-Lin., 30 perc test depth
Const. results for'3 runs
D. Hole log O.K.
Corporate Affidavit for other than individual.'
Authorization for engineer
Letter. from Water Supply if applicable ,�.CA
If variance requested -such noted on plans & apps.:
DETAILS
if change is proposed,)
Existing contours shown show new contours)
Slopes for driveway cuts, etc. shown
Xater service line location
Footing drain, etc. location I
Top slope, bottom slope of fill
P- rcolation tests and deep test pit location
Septic tank size and conformance to std.
3 B.R. house minimum
House setback shown
Distribution box ftg. below frost
All water within 50 ft:-of PL shown
Plan and profile SDS L
A7.1._..,o. her --wel a and SDS closer- 200.'
hewn or fef ererice made
Property boundaries (metes and bounds - clearly shown
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P. L.
20'•to Foundation walls
.00' to Nearest well
,�0' to stream, march, lake, etc .
15' to Curtain .drain
10' to water line (pits -20
15' to storm drain
10''to large trees
10' from foundation to septic to
5' to pipe from leader drain &.
. exDansi.on
ks
-e,)
Insp. by:
'�
- . . � s, .i . ._ . . .z ._:r_;'• /_ -. may'..: :.c. - • _-.� .
INITTAL SITE 111")PECTIO T �
Ycs
. No
Comn�en:fi,s
,Property lines or corn-m found .
Can csti.natc hou; e location .
Will driveway need cut ..
Nlu -t tree- be removed-note these e • . •
Is deep hole representative o'f' entire SDS area
AddiL, ional deep hole-S, needed. . . ..
Sufficient SDS area assailable considering
�'
�_ °Z2E. '� `
�
_..
driveway cut, house location, separation
distances, etc. . .'. • . . . .
DEEP HOLE DATA
Depth:
Water elevation: �-
Rock elevation:
Soils d.e cr:l ption:
Date:
I+IRAL SITE IWSt1JJCTIGY Ins . by:
House located where st_oi -m on approved. plan
.__.
�_._._
SDS located where approved •
.I.,c.nw,th of trench measured
Width of trench average
Slope of the line • and trench acceptable ..
Room allowed for exnwnsion trenches
Over 50.ft. from swanm.yat.er-c.our.se
i;a iiraa .z; u --!L- 1, 1?ot- s16Pi1) d or SDS area
tn?rjecessarily graded .
10 rt. maintained from prop-line and
20 ft. from house • . • • • . • • • .
Separation of trench from house, well
_
etc. follows plan . . . . . . . . .
'Number -of bedrooms checks . . ..
Stones, brush, stu .,ps, rubble, etc'. greater
than 15 ft. from narest trench . • . . .
15 Pb . of peripheral soil horizontally from
_
trench. . . . . . . . .
Junction boxes properly set
CoW.d surface run off fro ?n drivo a.y, roads,
ground surface, .etc .. chaimel near SDS
area . . . . . • • • •
Does lot drainage annca.r O.K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE
fa' 4" tij rT'
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