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BOX 27
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03321
x PUTNAM COUNTY DEPARTMENT OF HEALTH
i
Division of Environmental Health Services, Carmel, N. Y. 10512
s:d at
q
V
to Sewerage System built: by
Consisting of 001:1-Gal. Septic Tank and
Other requirements
upply: Public Supply From —
''-- Private Supply Drilled By
: .•`',i _ SYSTEM Alit.P
-Town or Village 4
Tax Map Block
Lot L J b
Address -•y
� /y T�—*�►'�
Address
Type 94. 1 ���- t No. of Bedrooms
n Control Been Completed?
"r \that the system(s) as listed serving the above prem
.1, and in accordance with the standards, rules ar
Car 7.
it Address
. - �;, 1�Mccupying premises served by the above syste s) ro Y
w ,esulting from such usage. Approval of the �90Ui
...Athe approval of the private water supply shall
�'."jdification or change when, in the Judgment o
BY
Date Permit Issued
shown on the plans of . he completed work (copies of which are
permit issyeq by t1WPutnam county Department of Health.
P.E. ZR.A.
License N' 2:12"C>
rtion as may be necessary to secure the correction of any unsanitary
)ecome null and void as soon as a public sanitary sewer becomes
a public water supply becomes available. Such approvals are
Ith, such re modification or change is necessary.
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental . Health Services, . r.armel.. N_ Y..,105,12 ..
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM +��` O� +\-- L,T►.NAiVM VA�L� `(
-`- ^X MAP Town or Village
Located at
V1: r-115"T . `A� �l.Jc� T �- Block - 1
Subdivision C /z N-%P LUat<cl)`( Lot Z_Z Job
Owner— Address 7,G7 Liooetl A�! N�duNT YL2a7od.l
Building Type Lot Area 16) 494-
Number of Bedrooms L U Total Habitable Space `V t-, P- Square Feet
e.
Separate Sewerage System to consist of 2 Gal. Septic Tank lineal feetA X width trench
To be constructed by ��prrf i .A�t Address t��rn� :� V4LLf
Water Supply:
/ Public Supply From
.L Private Supply to be drilled by
Other Requirements
Address X v 1 " sRrs ' _ _' - 1•T —r,
( (=Co'r Q Qo6 CPZAUEl. F ILL
I represent that I am wholly and completely re
above described will. be constructed as shown o
County Department of Health, and that o
be submitted to the Department, and a
place in good operating condition any
ante of the approval of the Certificate le
will be located as shown on the approved pi a
County Department of Health.
Date Oc;TC'p�';5 (Z,
PeT ovame_po - -5G-cv4tc G' /°r
location of the proposed system(s); 1) that tha - separate sewage disposal system
ere to and in accordance with the standards, rules an .regu a ions o the Putnam
to of Construction Compliance" satisfactory to the Commissioner of Healthwill
'h d the owner, his successors, heirs or assigns by the builder, that said builder will
sfj during the period of two (2) yeajs immediately following thedate of the issu-
t origi system or any repairs reto; 2) that the drilled well described above
ally in e�cordance withAthe star)�ds, rules and regu a-Tfions of the Putnam
w5i9 t /iCs� -�' P.E.-y/ R.A.
ALL off 1 ,
Address ice• /C'��t License No.
APPROVED FOR CONSTRUCTION: This approv a,.xpJres orl ga�r`from the date issued unless construction of the building has been undertaken and is
revocable for .cause or may be amended or modified whee sidered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. ,� �7 f�
8
PEEKSKILL ANALYTICAL LABORATORY
201 Buttonwood Avenue
(Corner of 202, across from Hospital)
Peekskill, N. Y. 10566 737 -8777
DATE COLLECTED,
RESULTS OR EXAMINATION OF WATER
C / � ,- .., It 06
TTY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE REPORTED
,AMPLING POINT
3ACTERIA PER ML. (Agar plate count at 35 C):
COLIFORM.GI9,QUP (Most probable No. 1100rri1.)
HA RD ES TAL -ppm
DETERGENTS - mg /L
NITRATES (as N) - mg /L
IRON, TOTAL - mg /L
kMMONIA, FREE (as.N) -mg /L
These results indicate that the water was L, 'of a satisfactory sanitary quality. when the sample was collected.
A. H. P DOVANJ, M.T. (AS P)
7� 1
ON
Si'.
MA
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER —ri M, A ()A PHONE9 4tl_"13q
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal: fran licensed professional engineer or
r i ed a itect.
.evJ e® is ,PCJ�
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V v1,c� " „�. �a��C - - e!* L -c._q- - - C l 1 ti, q k-e %r t.� %0-.-%0%- ' ' +..A .
Proposal Proposal Disapproved
Inspector's Signature & Title
Date
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points (e.g.;house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
C, as owner, or reported ag of owner agree to the above con�drittions. /
UGNATURE TITLE (06j N i�i� L DATE b Z
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DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ins, M. D.
sioner of ,Health - FIELD ACTIVITY REPORT - Sheet of
a �
.{
INSPDCTION
Orig. Routine
� ��
— Orig. Complain
— Orig. Request
Street. Town 24 No.
Compliance
,f��
s _ dam- Yd"r2 "� /°�/��/L -L 4/
Complaint Comp
— Final
:P.0. Box Post Office Zip Code
Group Illness
Construction
4 �i• n
Reinspection
RGE
ield, Sampling Only
D.�Sf�p11A ,�
✓ Field Conference
Name and Title
Other
TYPE FACILITY
TIME LEFT %l r
Explain
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TELEPHONE:
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K Signature and Title
PERSON --IN-.GHARGE .OR II�1'ERVIEWED:
I aclaiowledge vi
this. Field Activity Report. SIGNAT(AtE:
6/86 3j TITLE:
TELEPHONE:
A
9
i✓--, _ ,-a, , _. sr xr T. �, ... -• ze. f.F:.r .. -... =i xa_. -.v •., � . =.:,r�' :. ,.w •fa'.. `. -, . -•-+v v nos y - , o; o.. �ar. _� srwr...�i:W �� -.,_ .�..:a_•- ~+..`•....- �:+m�. -..!�'
May 199 1957
Mr. John Karel.l
Environmental Health Services F E',E ! V E 0
110 Old Route 6
Carmel, N.Y. 1051
-8-1 MAY 20 P 4 '49
Mr. Kare 1 1,
I am planning to add an addition to may house. This
addition, shown on the enclosed hand-drawn sheet, would
occupy space where the existing septic tank sits. I9 ve had
a couple of contractors out and it seems feasible to pout in
a new tank in another spot in the back yard9 as shown, and
to collapse the existing tank. This can be done,
maintaining the 10 foot minimum from the house. What sort
of approval or forms are required for this sort of work?
At the same time I hope to add two precast leach pits
to the fields. There is rooms for these pits just to the
left of the front of the hodse, as shown on the enclosed
copy--of--our, sgpt.n.c. Systems -, Plans. We
la mt o r. .;;;.ate fLdQr -f i e 1 d S presevnt ly ' inn apse � and gaunt i aa a
direct connection from the third junction box to the new
pits, thereby increasing the leaching capacity of the
system, considerably.
It is my expectation that the same contractor would do
both jobs and that the filed work would be done in
conjunction with the installation o f the replacement tank.
Please let me know what the next step should beg as
regards your office. My contractor is available for a
joint visit to may house, if this is required.
Robert K. Canavan
RD 2 West Ave.
Putnam Valley, N.Y.
10579
914-528-1688 - Homme
914 -SB3 -2290 - Work
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.,.TOOK RE PO4TNAM POUNTY p9PART"m ar
Nil Division of Onvirgnmontal Hapith Sm
COUNTY OFFICA PUII.DINQ - (m.R.m. N
Tble eapon III tq be cqMp1qtp0
al ity before certificate, pf construction p
M�ac i i r Vir 54V—um 14 1",
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETOONJ
Id
AD00933
;CCATIO4
(Iva. 4 street)
FrIFAIR-4 TOT WW
P
AIR AUPPW art
INDUSTRIAL 1:1 CPNDITI0 El Offl(OQ;ifv)
PQIL6IPffS
FU/COMPRESSED
L44 AIR PRACUSSIQN
CASLE OTHER
V9111CUS51ON LJ (11p;dfy)
LIMIRT11 &FU i
01406�94(lnchqo)
1WEIGHT PER FOOT
ffy,
mwlw�-
YOG&D
Top .
HOURS G.P.k
A J1 COMPRESSED Al E E?UMPQ
01,4440.4 FROM L00 6U0I?AC6—STA,T1C(6PqVfy foot)
PURINO YIELD TEST poot)
Depth of Complaftcl wolf
in foot bolowlLoncl purfo;oe JQ90
IPWAIP
MAP
LEIyOTp gf@N
APT 114
PJAMIT94 4v)
iF'r.404
PACKED
P19motor of woll 11) JU41ap
grovel pack (Imchoa):
MOO
P;qTH FQQiA LAV4 OURFACE
FoRtylATION DESCRIPTION.
okatch exact location Of well With 413t49004, 10 Of #Wj
two polmangnt landmafka.
FEET to FEET
Y
DEPT. OE HEALTH
If glald was tested of d1#114roril cloptho during cfrillinR, list bolqw
ROT
GALLONS PER MINUTE
P416 wit c It ER
54-W '017 IdEPCtHT
WIELI, PRU-1,ER (,SIQMt rql
..._., ..-. `!:�%� L;":''�'�3"'. %.V '- .".' "i � rvi�•{' _•,Y.�� �; ".., ...... ;.t.�,<.'-'� _ � .,.- _' i`7 �,� = `. �" u` ^• -h.1 �l�' � 11/fi/ ��- l%t`'. ........ .
owner �or Purc aser o Building Municipality t
Building ConstructE by
If V6'; 7-
Location - Street
Building Type
Block
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 success
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 _.Qounty..1�•en -q- rtm,-nt. -of - Health- as to i' .�e;;_c..er_�c '-b n t; : � �_�__.._:z, ..._�
= ?•a � -= ;f uZ U c7��-cc'u erat;e was caiis`ed by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this day of MJN 19-21,; Signature e ""
Title 0 w —
If corporate n, 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.
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cf: w{< �4LTK :4sr +.RV��i`ftK•v. >e�Y.OTCV.Cr. �yrM�._..+ h' i�Yi" �}. �w." �•. �' �^ 4i^+._..:' cJ�' X' �'��R��.+'IS��.C33^�.�..4'�Y4yP �T.�� >.:'0:��'^. �-�q .. �'�.m���ri�.i. d�.'O
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date S 3_
Re: Property of a L-e tF- k C'A Wa 2 ,�
Located aty�� V" 2 0
Cn,.&- Lam ff pp Sr'
Section lockQ -Ps't_ 1�Q Lots -E–ac� j
;°b.',c NA A? 54 3L c c iC "7
Gentlemen:
This letter is to authorize 6 Ae�l J. LANDER
a duly licensed professional engineer c/ or registered architect
(Indicale7-
to apply for 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
iepart1111GL.LU of nta' ; Ltii, arl' tU sigli a"! 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
:.1:3w -_ --the :Pd1b1i:e •Fow -1th -law ..... d, f.h. .... �,
tary Code.
Countersigned:
P.E., 4
STANLEY J. t WDER (seal)
A
AMAWALK H. Y. 10501
245 -2645
Telephone
Very truly y urs,
Signed
ne- Property
Address 14 eg"v
5 1 A- G '0� 4 - (—z V2
i-e-Lepnone
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F'Cit�Fj1,:LF• >!C. Nc'.✓ !� cY`,�.;r 4 .,, 1.39r;'t7
10J ELT) CiL►s(,'K LIST
Date.:
a
('/,Pnl r a� Lisp. by:
b b.
INITIAL SIT E 16 CT101 Y'es No Comments
Property lines or corners found, a a 0 a a
Can estimate house location o 0 9 0 0 .a 0 a
Will driveway need cut a o a a a 0 o a a _
Must trees be rerpoved -note these o o . o
Is deep hole reps °esentative of entire SDS area
Additional deep holes needed.. o . o- a a a a
Bu.ff icient SDS area available cone siederirig
dry. :veway cut., house location, separation .
!� cL Stances., etc. a . a 0 Q. a: 0 a' a• a a 0 a
DEEP HOLE DATA
Depth
Mater elevation:
Pock elevation:
Soils description:
— - Date: 7- -,U'
FRT-8 L SSTE INSPECTION Ins p. b
House located where shown on approved .plan.
3M l oc,?.ten T h,=!re approve a _. . 0 0 o a 0 ✓
�►daduh
of trench aiTerare
S1ope of t le lire and trcnc� acceptable a . a
Room all. owed for expansion trenches ` a a a
Over. 50 ft. Trom swamp, Trratercourse . a a a
X?: .1_�,.f "§o a t '.i •.1 C7 U fix �.1 ��' �l� Pd .-
unnecessarily graded a. o 0 0 a o _ a.
l0 F± o :r"aintained from prop e line and
20, .ft a from house . o o .. 0 0 a a -.0. a
Separation of trench from house.,: well -
etc. follows plan a a a :c a a o
fiber of bedrooms checks . . o . a` o 0 o 0 a
Stones; brush., stumps., rubble, etc l, ° greater
than 15 ft. from nearest trench . 0 o a
3-51L. of peripheral soil horizontally from
trench o a 0 0 a a a a o a a 0 0 0
Junction boxes prope_�ly set .
Could surface run off from driveway., roads.,
ground surface., etc. cr,a.nnel near . SDS , 0. . ;
area. o o a 0 0 o a o o b 0 0 0 0 0 0 0. a o 0
Does lot drainage appear O e K. ' in area of SDS
FMT, GRADING OF SITE ACCEPTAELE
q
. 7
/ May 19, 1987
Mr. John Karell
Environmental Health Servides
110 Old Route 6
Carmel, N.Y. 10512
Mr. Kane 11,
I am planning to add an addition to my house. This
addition, shown on the enc-1 °ased 'hand -drawn sheet, would
occupy space where the existing septic tank sits. I've had
a couple of contractors out and it seems feasible to put in
a new tank in another spot in the back yard, as shown, and
to collapse the existing tank. This can be done,
maintaining the 10 foot minimum from the house. What sort
of approval or forms are required for this sort of work?
At the same time I hope to add two precast leach pits
to the fields. There is room for these pits Just to the
left of the front of the house, as shown on the enclosed
copy of our septic system plans.. We would. cic�se...•�r1F�F. ±_era:_:....::- -.
^5vra� "Fa%i� "'jS7 iv"C7`i15GyR 11'i 115 @YYd' pltP.r 1 a_.... _ �..._. ..� -.
direct connection from the third Junction box to the new
pits, thereby increasing the leaching capacity of,the
system, considerably.
It is my expectation that the same cant Tact or wou 1 d do
both ,lobs and that the filed work would be done in
conjunction with the installation of the replacement tank.
Please let me know what the next step should be, as
regards your office. My contractor is available for a
joint visit to my house, if this is required.
Robert K. Canavan
G' RD 2 West Ave.
Putnam Valley, N.Y.
10579
914 -528 -1688 - Home
914- 683 -2290 - Work
--- ------- -- -
7
-------- - - - - --
I.J
P-
DAVID D BRUEN
County Executive
DEPARTMENT OF HEALTH
bivision Of Envirorunental Health Services
--'-s name and address
- W e. r
Date 'l
Re: Proposed SSDS
G
JOHN SIMMONS. MO.
Deputy Commi„ioner
Dear Mr. _ J
Re.vi_e:w ^_f_ n,'.ans__.-a ^ria: ��:T:i";.� �Y �.i:y:-u-%5c merits s =ubmitted
-- - �._dt 'f "ti's "`time Orel ati ve to the above - captioned project has been
completed. Comments are offered as follows:
du
UAA A, i,�r �� Ake Off
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
Yours very truly,
T%A /r1 rnl1NTv rFNTFR - r
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM
I
Owner Address, Z5 L . I Q DIE "Ave
-T-XA- MAP
Located at (Street) E5-r A\je 3uE See. _54- Block
. � V,/Indicate neares cross street)
FILE NO.
Municipality 7,T �+ AAk \/ALLC-:-1,(
Watershed
'"Outi-r k'/6-wa�.3
-7 hot 2 -z
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water
Wat-e-r-TEvEl,
No. Time
From Ground Surface
in Inches
Soil Rate
Start-Stop Min.
Start Stop
Drop in
Min./in drop
Inches Inches
Inches
2 10,'0'7 /0 16
57
3 io!08 /0'/8 0
4
2 IV"Z7- IZ- 4,o
4
2
Notes: 1) Tests to be repeated at same depth until a roximately equal soil
rates are obtained at each percolation test hole. Affdata to be submitted
for review.
2) Depth measurements to be made from top of hole.
I ..
Address
a
THIS SPACE FOR USE BY HEALTH DEPARTP ��lVL
4A Ho. 32�
Soil Rate Approved Sq. F Gal. `�
Date
{ TEST PIT DATA REQUIRED TO BE SUBMITTED WITH
APPLICATION
DEPTH HOLE NO. �� HOLE NO. --
HOLE N0. 'VTEf' dcuS
�c�cs« _
G.L. i:
t 7, PSc�t z.
al r0
a
611
12" % ACE CLAM - SA#J�' AC
18"
ar a'
2411
tr
if
3011
3
1f
42"
[�
1' Q
` 11
8
S j
5411
al
60"
66"
72t'
78rf
a
8411
�,vraTFi
..W111CH .GROIP?Da ?MATER - IS-T3N. - 7Q1T!`?`�'ER�D
. TESTS
TESTS MADE BY J, L A X.1 b Ee—
Date oc-ro e P ,- 43�, V� *V .
_
DESIGN
°AZT
Soil Rate Used 10 Min/1 "Drop: S.D. Usable
Area Provided
No. of Bedrooms F c 2 Septic Tank Capacity 1200-
Gals. Type M,4Sv0 i-' `f
Absorption Area Provided By f � 6 L: F. x2411 �'-
width trench.
Othex
Address
a
THIS SPACE FOR USE BY HEALTH DEPARTP ��lVL
4A Ho. 32�
Soil Rate Approved Sq. F Gal. `�
Date
AP!?2CtiCinitlTE�Y =i5 CU. Y;,3
-fit 0.1ds
fl 14
fit Itia 4,,
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