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T�oest�.on �fi�reet • t ,
Qe
GUARAN'T'Y OF SEPARATE 'SEWAGE 5YM
represent t at.'am whp�,�,Y. aod.Qmet� re Po pb or t. he i f
"' f eYta�l'
worl<mal7ahR materlal strvic f end na q,, tie aew $ d spgaal
drab
aervin tl above" do c'r p 'opertY� and that it harp been P911. trueted 'as ahown on
the apoya plan or apt�ved. aR�Qndman taret4, andn accordance ca�t�1 fi1ie, skandard
rules andtions o fiha PL{tn4iTl .Cour}t'Y Da�artms p Heal a aa�d 1erabu guar. apty
- to tl�e awneI� h 9ueeeQaa hex'.c►r aspgna� .dace �n.Qo�`n'Cat.�ng`RP�?d?tfan
..' anY parfi oF. ?sac aystem'po stx'uet .bY me W��ch a 1, p .oporq -t. e - o a per .qc gf p
years rimed afi Y fo1gF??i$ tie clt� °. q it} tial use of t1s seiage disposal sy& to t?, p
a i e aiz+s act e fi s c e-(Rep,, here thea ure to gpexate` px�ope?�l.y
is causal Y tip �aillEu }. or e$� aU qet p t}�e oq llo ?lt of ►� b airs i� � Z n
VIP 19
Q. und►si reedtl�ex+ a �,
g, , - ,, R 9� .es i'o soeept as ponellzs:i.ve. he cieter+m rat Qd
.. of te.:Dxdto!;ci: nevi PU n Efivro?1men�a Hea�tt► Sprviees of t}e lai }am Count
Rep art enfi .off aa� �1: asdJPq AeVhe;r or )19 fie f449VP Of rthe eYatpm " .o
°e f�usea:._by�tl�e_w � Eu ! " €o � q�' u�a} fi �U? u;
axr, �, pl . ,- Aso o ' t�# n�
systeM,.
Uaateq tb q- of 9? nature
ra Cad roc for
sp��-actoro .rt'Qn�vaam "ll adclxs
` f
TiIRE (� Co ? E3 AId>a RT;QLI A W T C 3) oPZ Pp FTC Ab PANS PUQ91 CUT TCAT,
f o COMPLI TFQN
QUARANTOR U RE D TO F_ NO Q ' D U6E QE SYSTEM
U --�—.—
.. ...�., .. .,.n.q. ^"} ^inn— "'T9l �I !:7 R++., !',7 G,t w.�n*7 ;r nn. nr!- �s*,"!r*ER !7 n!a ;�.n., {Z •n _... n.�-t, _ ,.r, ^I� �.,.. .. ,r .,.. .. r... ,
»i pion o EnVjranmentaj,, l PutUam. E911TIty ep t Pf Hea1th
PEEKSKILL MEDICAL LABORATORY
1879 Crompond Rd. Barclay Plaza Bldg A =Apt 1 4Q435
°"`° �T2 Ri��,: '�. "Y' 9�I C .:ziq a "�:: ..: =- .:» oz RC .`•+de's m . .. r.,;a c _ . c ... =�.. aiV4
.EXAMINATION OF WATER DATE coLLECTED
RESULTS OF
'5 11 =74
OWNER DATE RECEIVED
BOSWELL SUBDIVISION 5 11 -74
CITY, VIL .LAGS; TOWN VOR NAME OF SUPPLY DATE REPORTED'
SAMPLING POIN
LOT #6 BLOCK #j .:..
•BACTERIA'PER ML. (Agar plate count at 35 C).
COLIFORM GROUP (Moat: probable; ,IN6%100nl1.) ":.
E$S, AL 'ppm'
.DETERGENTS!,'.;. ppri
NITRATES (as N) - ppm
IRON, T9T -AL'-,0
b
WELL" dOMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE ,BUILDING - CARMEL, NEW YORK
_..._..,._.__T #;ss;:resart::is t: samp:�. d•: ;.� k! ri#! r-a:d s: s nittEd .10-Co!inty:-Health-Department tojether :%with. laboratory irIaart of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
G
OWNER
,NAjffi E � /
V 41 44 1 6N�2uC' / /6y✓
ADDRESS , /
1111 N. ,
ft 1A116
LOCATION
OF WELL
(No. 8 Street) (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
11 SUPP Y El INDUSTRIAL El CONDITIONING ❑ (S(Specify)
DRILLING EQUIPMENT
ER
El ROTARY ®A COMPRESSED CABLE R PERCUSSION ❑ PERCUSSION (S(Specify)
ds
J.
DIAMETER (inches)
177 HT PER FOOT
D THREADED ❑ WELDED
jDR�IV{E SHOE
LJ YES ❑ NO
W
EYES
C SING U D
� NO
WELL" dOMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE ,BUILDING - CARMEL, NEW YORK
_..._..,._.__T #;ss;:resart::is t: samp:�. d•: ;.� k! ri#! r-a:d s: s nittEd .10-Co!inty:-Health-Department tojether :%with. laboratory irIaart of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
G
OWNER
,NAjffi E � /
V 41 44 1 6N�2uC' / /6y✓
ADDRESS , /
1111 N. ,
ft 1A116
LOCATION
OF WELL
(No. 8 Street) (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
11 SUPP Y El INDUSTRIAL El CONDITIONING ❑ (S(Specify)
DRILLING EQUIPMENT
ER
El ROTARY ®A COMPRESSED CABLE R PERCUSSION ❑ PERCUSSION (S(Specify)
CASING
DETAILS
LENGTH (feet)
4
DIAMETER (inches)
177 HT PER FOOT
D THREADED ❑ WELDED
jDR�IV{E SHOE
LJ YES ❑ NO
W
EYES
C SING U D
� NO
YIELD
TEST
_ HOURS G.P.M.
❑ BAILED ❑ PUMPED COMPRESSED AIR 7
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST (feet)
Depth of Completed Well //
in feet below Land surface: V
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
1
�O
ry�..
=11Cj
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE W LL C MPLETED
6
Mn)�o REP RT
WELL DRILLER (Signature)
A17A
NUN.
MAY 11
To /UT
4 '
rvcroA-R
4 .1
0WINOWM91TALI
SS A
4u
W
OF
PLA40U
VA CON
DO
....... .....
I,X
LC
49
.3"
APP
A17A
NUN.
MAY 11
To /UT
4 '
rvcroA-R
4 .1
0WINOWM91TALI
SS A
4u
W
OF
PLA40U
2 As 43., -6-74 oie
PUTN'AM. COUNTY DEPARTMENT =0F HEALTI
Division pf Envic4nmental Health Services, Carme% IV.-.'.'Y,., 1'051 =2
CONSTfiUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM' ),L
r FI.G
(, Town or VJlage'
Located at
v— own
1 N � _..�•� �-,� -,• :n '-4 _ � �•sr ':"'�"'� - Block 7
Subdlv.ision o�sW�i- T��/+ F tf_ Lot _ / (',Job
Owner• ,� ®✓ Q• �AiS�� ( +B�G o Address ��ff. C`]UaNiQCV'l
8uilding Type . QC lT L'ot Areak'Ll fo� Q,R:ose-y
n Number of Bedr � Feet
Separate;.Sewera a� gx r z tc s s s a w
width trench ge5yemto al5ep .
<h ",� 5"
a: ^� ��s ®E'12l11ae�
To be constructed bey, Address -
Water Supply'' ublic Supply iFirom
ti u i
Prrvate.:su to be drilled by `�Z? —T
r
- sAdtlress',
e�
Other :Requirements
°County, iQepartment of :Health, antl Ithat.4n completion (hereof a .Cert�fi�cate of Gonstrucfon Compliance •sa[isfa
6e submitted to fhekiDepartment `rand a: ,wrdten iguarantee:;will be 'furnished +the owner 'hi; "successors ahe�rs or a s
place m ?!good operating _conditwn any Bart fof said sews d�spose�l system durmgr the °per`iod of ,tyi o (2) years'1'iri
ZM
of approval of .therCertif sate of fCoristruction :Compliance ofhe original system,7or any repairs thereto
will'6el16cated as'shown on the ap` rovedt 7en.�andithat sa�d'.Gve6 illibef�nstalled i 'accordance• with t•fie sta "n` "' ds
County Department+ of MA 41"
N ➢ hva
,r
t
SL
„A'PPROV,E❑ FOR CONSTRUCTION Thisrapprov,l expires one year from the date issued unless construction of�
`,revocable'-for cause or may Abe amended ofm&d ffJOd�,wN!nI,,qo nsiderednec slay by xtFie Com sinner of Health .F
r,,equire's +a new ,permit ApprFoved for disposal of:dorriest +': ry wage' sand' or` r= .aupply only.'•.
Date ;�
i t
o-
o tt:e Commissioner of Health will
i the builder, fhat said `,builder, will'
tely following the.date of the ' issu -
at the; dri(leo. well, described _aboye
nd regulatio_ns of the , UtDam
y .
PcE - R A
erase INo���
ildmgshas been un_'dertaken and is
9n11e. or- alteration of C ruction
y.
a°"
PUTNAM COUNTY DEPARTMENT OF HEALTH
efi %te �iJ:i .t .r .-° _.= ualia�%iw:' -...w «,.. . .._ter •_.-rR r ^l-X� �. __ _ .. -a . � _ _. ? ��«: "fir. _ _.......�a:P -yw�•. w'L':c�.�:.ty,�wr�:sR�•r'e'ea c�
�DI'1�ISTON OF "'ENV]:ROI�l�1�TAD 1�E11LTH SERDICE5 "' °�"-
Re: Property o
Located at
Date
Section boa— Block '1 Lot
Gentlemen:
This letter is to authorize f t'1 -Q �1. r •
a 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
Lv,ulCV L.LVII w1 L11 U116 ma L Lit• ailU to. Supervise ine construe ciuri of said
system or systems in conformity with the provisions of Article 145 or
-Public Health-i;aw; -and~=the—Pa-tn,am -County_ San - -- -^
tary Code.
Very t
s` F
Signed
Countersigneld:ti.
ss
Telephone
a,LL - k,\ -
•Telephon,
. _ ,FIF�'Ln . CID7X1,K LIST
Late.:
,....r.- ..:=+. a:. : r ua ...".' _•. -. .. re J �,. <:..,..N.riaa �....,..yrn.cv -,.. -• - -•.�.: ,ran _
°. Ins, bv
INITIAL SITE INSPECTION Yes No Comments
Property lines or corners found
Can .estimate house .l_ocati on
Will driveway need cut.. .. ,
Must trees be removed -note .these
Is deep hole representative of entire SDS area
Additional deep holes needed. . . .. .. __
Sufficient.SDS area available considering
driveway cut, house location, separation
distances, ..,etc.
DEEP- -HOLE. DATA
Depth:,''.
Water.elevation:
Rock elevation:
Soils.description:
Date: 5.9 7 1: T-
FIXAL� SITE INSPECTION ins b
House .located where shown on approved plan-
SnS l )ca:ted where aTprove
1t4
�.
.. •.. - �-
Width of trench average
.Slope of tile line and trench acceptable
Room allowed for - expansi on trenches _
Over 50 ft from . swamp, watercourse -
�- --• .. !� �z7'cz °3t31 ^-ii ..d'-o3''•'St�S' cl,��l,°
unnecessarily graded . .
..10 Ft. maintained from prop line and j
20 ft. from house . ,
Separation of trench from house, well
etc. follows -plan. . .. . .
Number of bedrooms checks . . .. , . . ,.•,4
A. `l
Stones, brush, stumps, rubble, etc. greater
than 15 ft.., from nearest . trench o
15 _ t . of peripheral . soil horizontally from
trench
Junction boxes prope_ly ..set
Gould surface run of from driveway, : roads,
ground surface, etc.-channel. near SDS
area
Does lot drainage appear O.K. in area of SD,'
.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
K;....�.,,..: f<tOUNTY"OFFICE -BU2LD'ING yrt�
,
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. S-1 6'L 90_1
Owner 1- V,2_4 q ,1tj , CQaAddress )b 6 01 ' 0
Located at (Street Seca ( Block ''� Lot (J
indicate near s cross street)
Municipality. SRmockm ocj[e� Watershed Pays
W
SOIL PERCOLATION TEST DATA RE's
ED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Water Water Level
No. Time From Ground Surface in Inches' Soil Rate
Start -Stop Mina Start Stop Drop in Min. /in drop
Inches Inches Inches
1
211'
a- a3
3 I1: 1S )0 a3 a4-
1
V :?S 10
1
to
3.
5
1
2
3
4
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
DEPTH
6"
12"
18"
2411
30"
361f
42"
48"
54"
60"
66"
72"
78 ti
8411
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
unr.P Mr) 1 HOLE N0. HOLE N0.
. • ^- 7,- ».'�- ^...��. :au .a .;'-5e - .:.•�a -r- •ar'.+crir . .. -..s. :�,�1: -� _ ..:s Cis -';., _.. --.x -r ,...,q::;
INDICATE IX4L
AT WHICH
GROUND WATER IS ENCOUNTERED
INDICATE LEVEL
TO WHICH
ER LEVEL RISES A
TER BEING
ENCOUNTERED
TESTS MADE BY
{ -� �(' C..�
Date a3 ca c-T
..- ,.«..z. �a= .�— ..- ..� -..o.: - .,..: -..� ....•.. •.�:.!�i.S 1.kai`!' c.:... .., ::— .- .•— • »....... .. .. Y` ..:..-- `�:.:,:::y »�-r. � .. -...+
Soil Rate lf'Drop: ' S.D. Usable Area Provided
No. of Bedrooms
Septic Tank Capacity —
Gals. Type
Absorption Area
Provided
By e L.F.x24"
. ench.
I?
Name
igna ure
Address
��
�. SEAL
P
�J
THIS SPACE FOR USE BY HEALTH DEPARTMENT T ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
Date
7,
48
L -T
Ivb
Ae
CT
4 C-A 1/ �lj PN
stP7r'
�. 1p.
174
;'r-
178
110
JUNCTION BOX
. 1 04
L A 11,4. -
PLAN
rc
MAN)AW COVER
4 MIN
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F IL
A P41 1 A
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a0 t
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SEPTI�-' TANK 6"C "-- 1) 'w
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oll" HAY
P PF,"-'R
CL GPj.-VrL. i R
ABS-" RPT tON TREW-H
2, TP 1. ah
NOTFS
L
V9 A�A
RFCULATIONS OF THE c,r o4 4,,-_, (;0UNT�!•DFPART1,iFNT
(D7
O HEALTH
v tx% T -r v 5- V�
SY:;TEM SHALL N()T 9I SACKFILLEC) UNTIL INSPECIErl BY DESIGN
kp PROVED
ENG!N FR ANC! iIIE LOCAL HEA1. TH DF-PARTNIENT OF REQUIRED.
SYSTEM Si�j 0� A 90-9-- GAL U)N sjf�ril; TANK
"Ti CON
A -T. qF--3—,F,r WITH AO'k6:,XINIIJM
ND SOC) F
C"
Pj:TcH OF i/IC' PER FOOT.
DISPOSAL, SYSTEM GRADES RILFERENCED in. Vj.Ni'SHED F!FfST
F 74
FLOOR ELEVATION ,UNLESS O'1HFRWI'*,F N. T FD.
r--23
S.D.
SYSTEM FOR VAL PET ECO'.�1R.Colz?.
TA 0 N
1311
C75 S W. f�.
E OR�- N ut
X-2 Cl-ml SEV SG
REVISIONS
IL
"T
A
u me-f k o 1-4 box f�oojtal.s 5 ET bE- Low �vsT. -I h IL
. 1 04
L A 11,4. -
PLAN
rc
MAN)AW COVER
4 MIN
M1,4
F IL
A P41 1 A
S E Cl'i 0 N i.
a0 t
CONC.
"W
SEPTI�-' TANK 6"C "-- 1) 'w
RT1%
aL.1,C PAPER
oll" HAY
P PF,"-'R
CL GPj.-VrL. i R
ABS-" RPT tON TREW-H
2, TP 1. ah
NOTFS
s (57 EM TO BE CONSTRUCTED IN ACr.OROANCF WITIf:THE RUE'ES AND
V9 A�A
RFCULATIONS OF THE c,r o4 4,,-_, (;0UNT�!•DFPART1,iFNT
t-Lj tA V., c'j T- wlNir4 ic, z'r-
O HEALTH
v tx% T -r v 5- V�
SY:;TEM SHALL N()T 9I SACKFILLEC) UNTIL INSPECIErl BY DESIGN
kp PROVED
ENG!N FR ANC! iIIE LOCAL HEA1. TH DF-PARTNIENT OF REQUIRED.
SYSTEM Si�j 0� A 90-9-- GAL U)N sjf�ril; TANK
"Ti CON
A -T. qF--3—,F,r WITH AO'k6:,XINIIJM
ND SOC) F
C"
Pj:TcH OF i/IC' PER FOOT.
DISPOSAL, SYSTEM GRADES RILFERENCED in. Vj.Ni'SHED F!FfST
F 74
FLOOR ELEVATION ,UNLESS O'1HFRWI'*,F N. T FD.
r--23
S.D.
SYSTEM FOR VAL PET ECO'.�1R.Colz?.
BUT Of ".VHS
1311
C75 S W. f�.
E OR�- N ut
X-2 Cl-ml SEV SG
REVISIONS
HOWARD A. KELLY, Jfl.'
ASSOCIATES f
"T
A
No. DATE
By
CARMEL, NEW YORK
TAX MAP NO. C72. BLK NO !L OT NO.
TOWN OF AA
7 s
�('?aV4--( -ChWL Wowing N..
4
:m
D Lv 1 14 Ao 5 -7 -507
And ap CI 7
- 5