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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 1
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
Tew. ., Village -
Located at ` Tax. Map, Block
Owner
Separate Sewerage System built by
Consisting of Gal. Septic Tank and
Other requirements
Water Supply: Puprrc Supply From'
✓ /Private Supply Drilled. By
Addre
Building Type
Has Erosion Control Been Completed?
Tax Map Lot $ Subd. #
of Bedrooms Date permit Issued
I certify that the system(s) as'listed. serving the above piemises were constructed essentially as shown on a plena of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regu ons, accor ce wi a fi plan, and the permit issued by the
Putnam County Departmentt Of Health.
Dat Certified by p "
P.E. R11.A.
Address LI nso No. v
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such uiage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the pr vats water supply shall become null when a public water supply becomes available. Such approvals are
sub)ect to modificatioh'pr chanlKwhen, in the Judgment of the C YK-Isslonei of Health, such Mocation, modification or change Is necessary.
Date _ BY. Title C#"—�
nl'
rOwN MEDICAL LABORATORY INC.
P.O. Box 0 321 Kear Strut
Yorktown Heights, N.Y. 10598
245 -3203
RESULTS OF EXAMINATION OF WATER
LOUIS MALLUZZO
!L I GE TOWN 6 /OR N A
DATE REPORTED -
{
LOCATIONS:
PUTNAM VALLEY., NY
❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203
11201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777
11495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335
TAP-. PARTRIDGE
❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330
DATE COLLECTED
COLI FORM GROUP (Most probable No. /100m1.)
HARDNESS, TOTAL -ppm
2/10/81 (11 A.M.)
4
0 MFT
DATE RECEIVED
2/10/81 (12 s 12 P.M.)
,:
NITRATES (as N) - mg/L
DATE REPORTED -
SOMERSET LANER
PUTNAM VALLEY., NY
2/12/81
'LING POINT
TAP-. PARTRIDGE
LANE PUTNAM VALLEY NY
'ERIA PER ML. (Agar plate count at 35 C).
COLI FORM GROUP (Most probable No. /100m1.)
HARDNESS, TOTAL -ppm
4
0 MFT
:RGENTS - mgJL
NITRATES (as N) - mg/L
IRON, TOTAL - 'mg /L
f�
)NIA, FREE (as WL
pH=
CHORIDES - (mg/L)
COLLECTED BY.*
JOE SEROLIMO
e results Indicate that the water
was YES of a satisfactory sanitary quality when -the sample was collected.
!
A. H. PADOVANI, M. T. (ASCP)
i
TOWN OF PUTNAM VALLEY
II�
WELL DRILLERS AND REPORT
L
This rep^rtlis to be completed by well driller and submitted to
Bldg, department, together with 'laboratory report of analysis of
water sample indicating water is of satisfactory bacterial quality.
Wall Location : �°° A i :rg.ra ► t: C.' `�I
Well Ow��er
Name
Well Driller
Name
CASING DETAILS
Length Ft.
eet Sec.. B1. Lot
..ld�✓are��� Cl�c,e._, ,t�G�uLrn L
Mailing Address City 45r Town
Tel. #
Mail g§ Address Y City or Town
IELD
ailed i (Measure from and su
or
umped Hrs. Statics Ft. Makes
ace
When Bailed Slot
Diameter_a*? ,
Inches Yields GPM or Pumped Ftj Lenath Ft.Size
Diameter In
TOTAL DEPTH OF. -WELL OU Feet
WELL LOG
Depth from -Give description mf formations penetrated, such
Ground Surface ass peat, silt, sand, gravel, clay, hardpan,
shale, sandstone, granite, etc. Include size of
gravel (diameter) and sand (fine.,_,. medium,_
stru -a;o ,-; as ; .paciceci.�.._...._. _
cemented, soft, hard).' For examples 0 ft. to
27 ft. fine, packed, yellow sand; 27 ft. to
Date Well Completed / a -/7 �/ Date of Report '
Well 'Driller
BZS 1 -77 Signature
TOWN OF PUTNAM VALLEY
WELL DRILLERS LOG AND REPORT
r
WELL COMPLETION REPORT
This.rep�rt is to be completed by well driller and submitted to
Bldg, department, together with laboratory report of analysis of
water sample indicating:water is of satisfactory bacterial quality.
Well Location
Tax Map Street Sec. Blo Lot
Nell Ow er il� � (!'.J .
Name Mailing Address City r Town
Tel. #
Well Driller&
Name
CASING
Bailed :(Measure from and surface)
Lengthy Ft, or
Pumped HrsoiStatic: Ft a Make:
"t When Bailed
Diameter:1 Inches Yield: GPM or Pumped Fta
Slot
Ft. Size
Diameter In
TOTAL DEPTH OF WELL ;-
:_� 4-10 Feet -
WELL LOG
Depth from Give description of formations penetrated, such
Ground Surface as: peat, silt, sand, gravel, clay, - hardpan9 ,,_ -- ,:_.. _
hale, sands tc:�e..4.wgarante; e;c °o Include size of
gravel (diameter) and sand (fine, medium, coarse),
color of material, structure, (Lose, packed,
cemented, soft, hard). For example: O ft. to
27 ft. fine, packed, yellow sandy 27 ft. to
134 ft. gr y _granite
;fee' to Feet
Formation Description
Date Well Completed %1 `v / i ` Date of Report
f Well Driller__ 2�.7��,�C'`r�,
B ?S 1. -7? Signature
�Ii:_' Divfs�on of xEnvironmenfa/ He
CO TRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEI
a
_u tr
on
n 6uilCl ype" S� Lot Area '
r$ NUmi f Be&oOTS
s Separ ewerage`System to consist wf Galri
TO be structed by �/-
45 Water ply ,�PGtil�c "Supply (From " ay
r Prrvate,zSupply to 1be'dr,illed by
� •, � s :Address - ` ' nP' �
Other ' liutrements -
I repress that i- am wholly and tompletely responsible for the tlesign andi
vvunry�pepartment�of Health r
•- , r q:;
sAPPROVp FOR CONSTRUCTION: Thin apprgval� expires one year from 4h
-- xrevocable far cause or may be amended or: modrf'ied when considered necessar
Iequires .a riew• permit ?Approved for disposal of domesti y sewage
n �
kRTMENT`OF HEALTH
i; Services, Carmel At. Y 1 U512
' h - Town or .Uilloge
LOL- S
g ;Address % / i.70 7 WC245 r, L 09AI.-
;s cyi�•evB o:.r N Y
�` Tofal Habifab`le Space ��� Square , Feet
tiaEankt �� y neal feet 'X L ' _width Srench
r
x, q Address �
R.t�rS
ition;., Of the proposed :Syste -w sp ,1), that wage ,disposal_ system
: to'anii m accordance;wdh thestandar N95 U6� s'o a urfnam
3-of uction CompUance Constr'"sati 9 t � r�ritiis or of Health will
I the owner his successors �he�r; or ny. th'e bw R Yha aid builder' will ,
l during the7period of•,�,two (2) y ihi la`t!ft,#p VWih to of theJssu
j or,igihal system or any!repa�rs f r t t, rl WWII ' cribed above;
I m accordance with the stand tl{; ule ns �c :"the 'Putnam
tk ° t ci's "•� o� °p
P. R.A.
O 7"0 N License gyp
e
e date- issued unless construction o e ndertaken; and "Is.
'
y'by then Isslonerrfof,AHealthi A. h 6#.Cf1t,. iorrof, construction:''
a1tl or prtyp.e water supply only
PUTNAM COUNTY DEPART. MINT `?OF HEALTH
_-
nTVISION OF J NVIRONMENTAI: HEALTH SERVICES
_.. � �
—_L _. ."•.- J..a -.. ...� -e �. .-4 :..3uw. J`�.. ..» ... iL�.� •._-• . _ .• _ _ _ � -... ._aa+. _. '.t, -- =•a. ., �.. • . ..t :w -b•. .4:•+ ,•_K
COUNTY OFFICE BUILDING, CARMIEL, N. Y. 10512 ,..
.::
DESIGN
DATA S..TIEE''- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0:
Owner
levi3' /rlpce viz zo , %1A Address gd, egg- !l'/ ZA Al. Y. '
Located
at ( Street ,a,�s���G� LA. Sec . 69 D1ock_I,ot
-
Indicate scares cross street)
Municipalitypyr^o " e,1.44 Watershed
SOIL PE RC01XVION TEST DATA RRQUIRED TO ICE STJ13MITTED WITIT APPLICATIONS
Hole
..Nu'
ber
CLOCK' ':CIM!? l'I?:RCOIJITION PERCOLATION
Rai,
aPs'0 Do, pt i to Water Water, lovel
t,
No:
'.Came From Ground Surface in Inches Soil bate
Start
-Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1
/'a •oca- �o �30 �� 20'' ZG �, n G �. �, ¢.6' 7,-V / a
2
rp 3s' J /'os' 30 20 '' 6h " G �4 ' 4 B /,V A/
4
5
'
\O
TEST PIT DATA REQUIRED TO BE SUMITTED WI'�7fl APPLICATION`,, LAPPLICATION`,,
DESCRIMON OF: SOILS ENCOt a'Ci:RT. IN T:ST f'OLi?S
_ , -: `., r_s ;.s 3:...r = °.,Y�_.::.. ,; ' '-, =z:- - +.,...:'a� el+ a _. ` ' <�.y «"�,.c 's. i..:• -r' P ::.irt..\. -° 3._. �:i; ..:._ �i..� ...�r�:.a '' -.� c.v _ :vi_rs
W
DEPTH 810LE NO. _ ® 11OLE 'N'D, HOLE'. ISO , LE R.O e .� ���„� '
COLo �/J •4oiL :70d -50
6°° . it N
-- �---°�
Il 20B 1�&T ,�o c.�n0 'SAN ,0Y � p'll" �.u17
24'0 -
3010 0�
3600 • ri
4290
4800 v
5400
6000 R.0 eA-
6600
7200 m
7600
8400
INDICATE Y.)aVEL AT WHICH GP.OUND WATER IS EUCOUNTERED
INDICATE LEVEL FOR WHICH WATER LEVEL RI S AFTER BEING ENCOUN72RED
e�✓� iG DAT ��. A lf ® C TESTS MADE BY
DESIGN
Soil Rate Used Drop:. S.D. Usable Area Provided 5ca(" o S1
No, of Bedrooms Septic Tank Capacity 115700 Gala. Maaaonry tt meta2,�eO,,_,
Absorption Area Provided By L.Y.x2400 360° width trench. Other
�.�..
77. F ME
Name,
km,, t �9 eez eai ?g�,g jr,� . Signature
SEAL
ddirosa
�. 1 2'00 �p
i'utrlcn Co�neety Health Department ° "ac.frGlnEE "b
Sall Rate Approved 0 sq,Yto /Gale: Checked day ®ete
TOWN TAX MAP,DATA
Sec.1jobQ9 Block 4 Lot B
NOW OR FORMERLY PERRY
N-299361 W E 189.15'
c�
cli ft
LAi
309
_J0 EXISTING 1.1021 Ac.
o WELL A PP
(48,009 S. F)
t
16.6 jQO!W
AG. duo a
FEB 11�
0 Ti
3494- -,w
55.Z4 Fr. 0, g .
ger.
-0 Southerf sL
�fo,th
rA (I
EM
y. 301110reet Line 0 , , — ,
.
1,64 0
E. ,
r.,
71JI177. -e
IAJ
(N
0,
NVI I
'bl
1 r' 34
IVA
6t'L:S H OWN HERE . ON KNOWN AS LOT No.39 lb
MA ENTIT
LED SEC. B OF PUTNAM ACRES"
FILED'IN: C(iUNTY, LLkkd OFFICE AS MAP' No. 815 A.
itf
BJECT TO E' T91CI AND/OR TELEPHONE CO.
LE6 CERTIFICATIONS INDICATED HEREON SIGNIFY THIS SURVEY'�
.,EASEMENTS,IF ANY; FOR OVERHEAD AND/OR WAS PREPARED IN ACCORDANCE WkTA.THE EXISTING
UNDERGROUND; SERVICL 'ADOPTED BY THE NEW
OF PRACTICE FOR LAND SURVEYS
YORK STATE ASSOCIATION OF PRUFESSIONAL LAND
SURVEYED AS IN POSSESSION,(No Linesof Possession SURVEYORS.
Other than Indicated).
SUBSTRUCTURES AND/OR THEIR ENCROACHMENTS SURVEY OF PROPERTY
BELOW ,GRADE, IF ANY, NOTSHOWN.
-HOUSE OFFSETS TAKEN TO FOUNDATION'LINE. PREPARED FOR
PROPERTY CORNERS STAKED FOR BLDG. CONSTRUCTION
PURPOSES ONLY.
MALLUZZO REALTY CORP.
'CERTIFIED"ONLY-TO:
LOCATED IN
LMALLUZZ11 REALTY CORP.
2
3• ,-TOW W OF PUTNAM VALLEY
J. HENRYURPENTER 8 C PUTNAM COUNTY, N.Y.
Fdl V 11 ENGINtERING. &.LAND SUR
VE
, 10b .
iYORKTOWN HEIGHTS NY
A ;.1 M
fifications Hereon are Valid for'This Map. and Copiss Thereof
HeoTy Carpenter 8 Co. Do Hereby Certify Tho I OnJ I nly if Said Map or Copies Bear The Impressed Sect of The Surveyor
a Survey of The Premises Shown Hereon Wo Made and ThotThis Map Whose Signature Appears Hereon.
is 'made in 4ccordpace ith The eld Notes of Soid Survey.
Alterations of This Map Other Then by a Licensed Land Surveyor is illegal ::
SCALE 1 " =60' DATE:' i.jIly30,1976,976i 'A',
41C HARD A.- SEABOL-PTJP: o.49010 2.
!i 5'
S U R V E Y 76 it:126,
-
�VJ __ter
w t
ia
ioo 91� m
1 �
6': 36 W 272.6
It
d v N
Ja
,ice � t • > sli '� o
O wx� y g4
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