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BOX 27
03438
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03438
cTlEWA
Water upp y-
-1, 711
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Building, Type
r °, JcerMfytthat s s
V-AMTNAMI"
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servingthe �pr
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'j-Putnam oun f
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h' Ion as ma be necessary to secure the correction of any unsan
II` 'rid'401d,�,aysoon- 4� a,pub,ijic..�"n •
;conditions resulting �4rorhl such ':usage .,:' A itqr becomes:
available and the approval of the private water supply shall a n _a i v i q supply ,becomes available i Such a r als r
modification or �:pay!gg,-,when ,-..tr in -1 as r
—7n
Title
.10 r z. dpi: T 4',
if
Location - Street
Building Type
GUARANTY OF SEPARATE SMAGE 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 successors, 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' ratigr 8 by t1io wil.l_fiil_. nr nocTl ivnrit not of fho onrninant of tho hiii 1 rlinrr it-i l,.i.?i.nrr
Lcrt
of the
The undersigned further agrees to-accept as conclusive tiie determination
Director of the Division of Environmental Health Services of the Putnam County
ient»:af.JJeal,th _a. to_,whether...-or not the _failure- of the _ _sy stem, ..to;- ,op.erate...w.as,
Tay` "t�Fie wi>ai'or 'neghiben`t act-`o "`f°ir3 occupanf"o%`"tTe `bui3'ding'utiTi'z'in'g t7Te `�
system.
Dated this day of C 19 Signature,��
Title
/.�
%,'
,__S_
zt, Z1414
Owner or Purchaser of building
Kiniclpality
.Building Constructed by
/tj,q -lo ._.
if
Location - Street
Building Type
GUARANTY OF SEPARATE SMAGE 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 successors, 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' ratigr 8 by t1io wil.l_fiil_. nr nocTl ivnrit not of fho onrninant of tho hiii 1 rlinrr it-i l,.i.?i.nrr
Lcrt
of the
The undersigned further agrees to-accept as conclusive tiie determination
Director of the Division of Environmental Health Services of the Putnam County
ient»:af.JJeal,th _a. to_,whether...-or not the _failure- of the _ _sy stem, ..to;- ,op.erate...w.as,
Tay` "t�Fie wi>ai'or 'neghiben`t act-`o "`f°ir3 occupanf"o%`"tTe `bui3'ding'utiTi'z'in'g t7Te `�
system.
Dated this day of C 19 Signature,��
Title
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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,__S_
if corporation, give name ana aaaress
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
TQWTT OF PUTNAIv�' :VALLEY t _
,'..; r �..::�;k: -t',.. ... �. .. ..i::Ew!-i •' t ' — 'yam
WELL LOCATION
street ... _..=section bock __...... - -. :lot
WALL url ;pp '
nW e • a ress' city .6r toXh
IWELL DR:ClLER,
uengh
�TAL DEPTI. 0 2 WELL Feet
Ground -Surface
9�^
', lt; san1,:--grave,, clay, hardpan, shale,.sandstone,
granite, :'etc. Include siza of gavel(diameter.and sand
(fine, medium,' . course)., color. of; .material, structure
(Loose, packed, cemented;; soft, hard). (Ex.: Oft. to 27 ft-
P; zip
•
/- (., oc:- ..•,�^.n:rn.r'i ,.y:`Y i`r.+:. .+•.: _.iw. 3�.=:M p7*,•s �d 1�'Tis ,•tW'as+.voeie.is-
_
♦ a .ass ;y r tv a.S4a��', f�,f �V SF: �.c -4r ':y +a..R Tf -
' ..
�a•...
.�.Z"•'° .. ...3
'
`.6
far �h b;, • I9`75
Tb. WIwir, i. t. May -Concern
rsa1 tkigt the d.l s, nce br, w,reer: the dr �Ieu. u3el'i 0n, V,
_ Property on Kiawer.s Frm'd 'oad Town,`of PuLn�m vUl.e Q .Lot 13•;,
tK2:ock .l, '` ,6x Mar, 72 is apppq•xiD ate .y ('3 2 .feet; fro t:: , ��'� :. exi''sting
.;ev IC• S.� iS :em ,or, the K el , .Up -r t;y L!.�t icy 3ectl0n .A'. SU,Iill t
�..
Acreso -
ec6.pt 'tht., st,unce c, n-3 F rehy r.�':l irc then fiPex
'.'
"tnnj ey a ,anr .r end the thani C,;,unty Sri tpent of I AiO.th
frdm any, r'esnonsi -bil t;' a�s6c4ate( t;f, �wt Y>iz.
Acccord t g.1 y { h ei, e. by apply. for 1 -1 -1P
Very , ,t "r Y fu v v ;g '
.. • ,
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sAMPI.E No. 3327
SOURCE: Handel
Kramer
Putnam
COLLECTED: O C t o b
. BY: Louis
BREWSTER LABORATORIES
'°� �" i�.
.:b�LL •tr:��j:: •lRR.�' � : +w%-6 :y,:. .. ' .mow'. „:x:..:..ro w eer H, a..�........
WATER ANALYSIS REPORT
(owner) - new well
Pond Road
Valley, New York
ar 30).1974
Na l anchuk _& Son,--Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method per 100 ml.
This result
indicates the
source of
the sample was
of satisfactory sanitary
quality when
the sample
was collected.
Nov. 2, 19 74
'Itdy' Bickwit P. E.
Director
sKY
0,
CONSTRUCTION PERMIT C •u
C
Z,6
jt
Al A`4
rt
Building s
'
ljw Loi
,,Separ,a e�Sewerage,SyA,
To be-.e6hitrucled - by
, Water,4Supply i.
Other . Requirements
lbl.ic'St
�lv
i.dress
Ty'otal� `Habitable Space Y Rm-
tl;
Z7
f. T6wn, or
+VzIlage
k
j
Ty'otal� `Habitable Space Y Rm-
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Z7
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vqcr-,a,.iJ .4
PUTNAM COUNTY DEPARTMENT OF HEALTH . p
.[ ^J'GN,•3f.R' � 1'9'x. t'_L` - C�.:f.T�NO•Cr. ':. �-.�. ,,T �k -r L T r .. ",�„�c��!�.tic,`r.. o • .laff WML.z• W..�- `+.tw; - i..r "tTQ•OC' ." ••;Cr. T....�j D�1'ST- +1'..i. ti�- r*T,Y:N..r�,.. �R4r+'.f.. �9{'1�V: 1
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property c
Located at
`% 1. Block 0% Lot
Date -/I& Y /6, I- -�
T
/e /j ./
Gentlemen:
This letter is to authorize
a duly licensed professional enginee' or registered architect
(Indical-
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
icpai iiiciit . Qf HCS,ltii, aiid tL Slgn all riecessary 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, Education Law, the Public Health Law, and the Putnam County .,Sani-
tary Code.
tersign
P.E., =., # Zf-- 20
. LAMM
STAB �- J _(Seal)
A res�� 26
A.M .A V�AIKP!- v_ 1®.O 1
245 -2645
Telephone
Very truly
Signed
allS-- 13 V
Telephone
I
I
t F e V V'I t� P-1 'L LL" v -L LE4 UILUJUE Orlblt!'T
i.broj t
Meets
Std.'
Mr%
DOCUMENTS
067s�e p-1
1 an§ O.K.
Design data sheet
Peres presoaked?
Min.. 30" perc test. depth
Con.A. results for 3 runs
D..Hole log O.K.
Corporate Affidavit for other than indivd
Authorization f or * engineer
1,etter from Water Supply if applicable
If variance requested-such noted on plans
apps.:.
DETAILS
if change is proposed,,)
Existing contours ours shown Rhow new contours)
Slopes for driveway cuts, etc. shown
Water service line location
Footing-drain,, etc. location
.Top slope., bottom slope of fill
Percolation tests and deep test pit location
Septic tank size and conformance to std.
3 B.R. house minimum
House setback shown
T
All W'au'ev -withiu D6, J_ L, . ul 1-L bliow i,
Plan and profile SD8.
All other wells and S S closer 2001
shown or'reference made
-P-r, -bb ;L own
V/
Remarks
SEPARATION DISTOCES SPECIFIED ON PLANT
101 to P.L. v,
C:V to r ou da E I on walls j V i i
001 to Nearest well i / I I
5 -I - 1 -4- r , _9 _/ I i
V I stream, suream marc
151 to Curtain drain
101 to water line (pi
191 to storm drain
101 to large trees
10; from foundation to septic tank- i
.5 to pipe from leader drain & footing drain
• iZaOYI
' ••.' "� Ins. ��
1I1ITT -AL SITE IP•ISPECTION
Yes
Ng
Ccrrments'
.Property l:i nes or corners fc•,;-nd :• .. .
J
Can. es-timiate house location
Will driveway nee? cut . . . . • .. . . •
Must .trees be rernoved -note these . . 0
1 ✓
_
Is deep hole r. opresenta.t_i.ve of entire SDS area
Additional de 'a holes r_eed.ed. . . . . . . . . .
-
-' 1
.
Sufficient SDS ar�.a available considerinc,
-J
driveway cut,house location,.separation
•distances., etc. ..'. ..
-
DEEP HOLE DyTA
Depth:. •%
Water elevation:
Rock- elevation: ---'
Soils descriz) on: irS. G`' G�- 7` 1 �th�:/��
Date:
FINAL SITE 'PTSPEC'�'I0.`T Ipso. by:
House located where *shown on approved plank .. .
•✓ry_s;v.• ._L w•:y . -r.v ... .._• . � C•v,l'i.. '.V 1^ciV • • •. . . . • . _. ...._ .. •._ _ • _ __... ... -
Width of . trench avera-ge
Slope of tiiel line and trench acceptable _
:Room alloyed :•'or eXl- lansion trenches _
Over 50 ft. -Lrc-,Li swamp :�atercovrsa. _- �• _ ..
s -t c 1ppe or - S• � `c` Pea
unnecessar i l V gra-;e1 -
10 r t . maintained from _nron . line and
2Q ft. from house . .
Sspa.ration of trench from house, well
etc. folious plan 0 . . . . . . •
N="Der of bedr.oams checks .
Stones. brush, stur::ps, ruble, etc. greater '
than 15 ft. from nearest trench . . . . . .
-15 R. of peripheral soil horizontally from
trench . • . .
Junction boxes pronelPly set
Could surface run off" from driveway., roads,
groans surface, . etc.. channel near SDS ,
area . . .. . . . • . . . .
Does lot draina ;e anti: ar O.K. in area of SD `
FML GRADING OF SITE ACCEPTABLE
PUTNAM COUNTY DEPARTMENT OK. HEALTH:.:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.'
OwnerJ,C-Ac EY 1V4,►/AC4 Address RD '6/ r&dciyX6ap A_rA1A,0,1 1XI"46e %UY
T4v.H '
Located at ( Street � �.✓A ®- j - 72 Block eel Lot f' /O /.3 -/
indicate n�eaares cross s� -ree
Municipality�r -4/ a� / erawf (1�yt.Z _Watershed ,c!ds,C' /L� 4��4✓ , oc►�
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number
CLOCK
TIME
PERCOLATION
PERCOLATION .
Elapse
Depth to Water
Water Level,
No.
'Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start Stop
Drop in
Min. /in drop
Inches Inches
Inches
pi 1 , si
44'420
I
/74( 01010
3
�•
2�. =�J
4 r!�
to
/71
3 4.1Y,4:
Zz
/°
/ le
3
3 3
4
AN
2 4:4z
3 /.F d / � �'3
4
2
3
5
Notes: 1) Te'�ts 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.
3611
4211
48"
5411
6011
66"
7211
rr �
n
p
7811 �
8411 61
:= Iv: "'T h �v yIi G.Pv ^UI�'?? e r ^• T, F.F. TS r ]ETC 0[}1`.T'I'P P,ED !97`x"
INDICATE LEVEL TO CH WA `' IJ -t�ISE N "1' r�" 13L 11�1i - E1dl.UOiU TEi
*. !PESTS MADE BY Date � - 15174.
DESIGN
Soil Rate Used 4,� Mi.n/l "Drop: S.D. Usable Area Provided Sxv-Z
No. of Bedrooms " 3 Septic Tank Capacity do Gals. Type e- �•��._
Absorption Area Provided By L. F. x24" Jb"-. width trench.
STANLEY ,EY I . LADE�
Oh
her
Addres
THIS SPACE FOR USE BY HEALTH DEPA4 AT
Soil Rate Approved Sq.Q_y Date
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
TTi�I^�?TkdT7�nTT Op QnTTQ Ti�TT�!i1TIiyTF1R T T;T T� ^.m
unTF
DEPTH
HOLE NO.- jaj
HOLE NO. P
HOLE NO.D6givo
G.L.
.dl
1811
r,
2411
3011
b
3611
4211
48"
5411
6011
66"
7211
rr �
n
p
7811 �
8411 61
:= Iv: "'T h �v yIi G.Pv ^UI�'?? e r ^• T, F.F. TS r ]ETC 0[}1`.T'I'P P,ED !97`x"
INDICATE LEVEL TO CH WA `' IJ -t�ISE N "1' r�" 13L 11�1i - E1dl.UOiU TEi
*. !PESTS MADE BY Date � - 15174.
DESIGN
Soil Rate Used 4,� Mi.n/l "Drop: S.D. Usable Area Provided Sxv-Z
No. of Bedrooms " 3 Septic Tank Capacity do Gals. Type e- �•��._
Absorption Area Provided By L. F. x24" Jb"-. width trench.
STANLEY ,EY I . LADE�
Oh
her
Addres
THIS SPACE FOR USE BY HEALTH DEPA4 AT
Soil Rate Approved Sq.Q_y Date
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