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BOX 27
03376
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03376
Date
Date
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PEEKSKILL MEDICAL LABORATORY
.1879 Crompond Rd. Barclay Plaza Bldg: A, Apt. 1
b
?n
DATE COLLECTED.
RESULTS OF EXAMINATION OF WATER ,
0WNER . DATE RECEIVED
()rChrtrd, Pkcz rrqon - 76
CITY, VILLA E, TOWN &/OR NAME OF SUPPLY,. DATE REPORTED
L -# 0 j v le a1-
SAMPLING POINT
BA7 RIA PER ML. (Agar plate count at 35 C).
COLIFORM GROUP (Most probable N6. /100ml.)
less
HARDNESS, TOTAL - ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm
FLOURIDE (F) - mg. /1.
These results indicate that the water was �CS of a satisfactory sanitary quality when-the sample was collected.
e
A. H. PYADOVANI, M. T. (ASCP)
h
TOWTT_.OF PUTNAM.-VALLEY
Wj.;uIL,DRILLEIRS LOG AND REPORT
WELL LOCATION J E:0,Vj t,3 A-- 09ovLt.
street section block lot
i.a.IL OWNER- a Cb)li
n -` N
address city or town'
4ELL DRILL''
ailed (Measure J.rom 1 d surface5
Lengh: feet or
Pumped - Hrs.. Stati,., &ft- Make:
en Bailed lot
Yield:/n
Diameter: Inches GPM r Pumped 710 ft] Length Ft•, ize
r
6
nd *5 2-4 El. f Diameter Inj
20TAL D L
DEPTH OF WELL__
^�epth from 'Give -description of:forma-u-ion -penetrated, such as: peat-' -
Ground Surface silt, sand, gravel.,* clay,hardpan, shale, sandstone,
ranit'e, etc. Include size of gravel(diameter and sand
fine, medium, course), color of-material structure
(Loose, packed, cemented,'.soft, hard),(Ex. Oft ..:,to.27 ft.
yel -pranite),_
jow
p_Acjtd
la t' D s loff 6 E; r n
tioj kotb exact loca ibji (3f V&li -to
perenan a)a mar .s
least two m
. t L _d; k
4 'r, IV
mate ','.4e!]- Completed 75 Date of 'Report 75
Well Driller
signature-
s ar rR . L-" .^ .+✓i ~J.JY �...L.�r.r.U[.�:.. �,f t.. ..arw6".� ..� n - s.+v�t
/> o s
-� � V � n-w � a.N� �:r.0'F.J... �ti.:4 .. "��i4✓'��i�'-� {S•'.�.]P f ..a n im.� +., r . -i
Owfter or Purchaser of Building
�cti. uL
Municipality
Builddiing
Constructed by
Section
Location
- Street
Block
Building
Type
Lot
GUARANTY OF SEPARATE SEtiIAGE- 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 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. the. Director. of the. Division cf Environmental Iie ^�lth Ser -_
vices of the P:atnam 'County` f�epartment 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 C� day of 5� 19� Si nature � ��
T i t l e ' � / /i"(llGfii &
(If corporat bn, give name/ :yC.
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR..'-LS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
x,
To.
2
3
G
7
A
�o
54
5?
51
54
59
6
21
PUTNAM COUNTY DEPARTMENT OF HEALTH
1-kU -ALR W`
Date Id /970
V
Re:, Property of I-
LA 7.
Located at Z4--.4 'IV,1V4r_ 121 Ve-
Section /,,13B -Block Lot
Gentlemen:
This .letter is to authorize
E(:"duly licensed professional engineer or registered architect'
(Indicate)
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,_Ed.ie.ation- Law�,_ the..- Riblic... Health La•tt, and
Count ri
tary. Code .
Countersigii
8998,4
P.E, R.A.,
cu .4 ye
Address
Telephone
Very truly yours,
Signed
Owner ofPropet*
/0 C124AWVAEA) Ara-
Address
dof Q
Telephone
�.- ;. -. .
..,. .
,;
� n � 1
.�..
'.
,.
.. 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 N0.2498 -99'x-
Owner Address /06r,,v",2/
Located at (Street Sec. Block Lot
�Indicate nearest cross -street)
Municipality
SOIL PERCOLATION TEST DAT
Watershed
?ZAMA
TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Eiapse Depth to Water Water Levei
No. Time From Ground Surface in Inches Soil Rate
Start-Stop Min. Start Stop Drop in Mini/in drop
Inches Inches Inches
1 1A 3�
2 ,0$a
/0 7
o20314-
J14
3 If
090 %
Y14
4-4
5 /1
40 ,<
in, 0 -
624 �� B2 �z
l %- ���
�2
3-
5
2
3
4
5
Notes: 1) Tdsts to be repeated at same depth until agroximately equal soil
rates are obtained at each percolation test hole. A data to be submitted
for review.
2) Depth . measurements to be made from top of hole.
DEPTH
611
1211
1811
2411
3011
36:'
42 1
4811
5411
6011
6611
7211
7811
84 if
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO.
AI
HOLE NO._
HOLE NO.
INDICATE' LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date 1 a CMG 2714,
MT L
Soil Rate Used__Cpo Min/l"Drop: S.D. Usable Area Provided s-em,,
No. of Bedrooms Septic Tank capacity C?aq Gals. �--Tenchp44M
Absorption. Area Provided By__4��L.F.x24
ure
Address SEA .
THIS SPACE FOR USE BY HEALTH DEPARTP/Ml T ONLY:
Soil Rate Approved Sq. Ft/Gal. Checked by Date
'I
-PLAN t.
,MANHOLE
C(:V
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A. '
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Q� r
t
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t
g }p qq ��►►p GRO GEVE Y
10 \ ^JUNCTfON BOX ram fz' =ie_ A t,
F _ 4 N..' I
zo
BAST If:7N. .,
:iANiTARY fEE ,
. �. SECTION:
48'
L JT P L AN CAL TYPI CCINC.
Rv F .tI:NE F. cs a `st- ; .. p e. oBN/Cw
I SEPTIC TANK .
1 �
YSM ^� 1►
nar4n6o
;3R!). ;'LEVEL
EARTH f <,�
SACKFILL J01A -�'
CO,VER - -
a aLL� ao
� 1'R"•30' BLDG PAPER
OR HA: 2.
...-� i -,`� -► Q6. f I'J , FRFORATPf PC 5.
56, Ci EAN.Cg9AVCL OR
a �l \� "' �Zn ✓ �L .0 3. "� -"'I' 4RJSHrD STONE!
iQ`���r S�i �i ✓I tom• AASORPTtf?N�TFiENCIi<
C� O _---
I 1 i • �j /' NOTES *s
C' I (J s T, q o St:S EA4 T� BE E)NSTRUCT1;�IN ACCORDANCE WITFiJHE RULES AND
} .oJ RFCULATWNS.OF THE ufnc<m GUUNTYipEPARTMiE :N'f
,� 90o eT I• Fi `T t� . OF HEALTH. #.
59�pn Sept c � iti o j �' r' SY3TENI SHALL NOT BE BACKfi.ILLED UNTiL.IN °PECr1ED 8Y DESIGN
k y9"1 "4� g�xeS _ ENCtP.IEF.R AND THE. LOCAL
HEALTH •'CiEPARTMEh7TIF REQUIRED,
T i
SY, __M TLS GONSiST OF A _�GA.LLON 5t TK TANK
eC +ion A1dDBOO FT. QF_3 —,FT. TRF-N[.H wiTH A.1sm,\X1M1jAt
Pi7CI-i OF 1116 PER FOOT. ;<
N.T.s. DISPOSAL SYSTEM GRADES RE.FFREhICED TO FINISHED FIRST
S.i Junciion Box Foo +in3 Se+ 15.1c v Frost Lino FLOOR ELEVATION UNLESS o TkEPW ISF N`.7tL•.D.
21 S.e per. +ion .Dis +0.ncP_o SS(3 10 Leader fz)—in-
IS Ft. ./v\inimum. VA L- PETE
$ All .Lar e.Trees .Wt}hFn 10 of IJ sPos -1- S.S.D. SYS'TERA FAR_. -.
A.rea�:'To. 6e'. Remove -d,'. .. _ .. ... ' R vtS1oNS HOWARD A., KELLY
ASSOCIATES
CAkNIEL NEW Y RK
AQPRo s� ,I a r t 1 �b 15 ►3�iK� 'MAP NO.1238BLK,.NO f1LOT NO_ Sh
woaa ,f o a o� a t 1. TOWN Of
_ �b� growl L3.WV. •Seata0._s ro'rad atudof
CW& Uafe:B 14�g DigN n4 H.
X9087
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