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03492
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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE, FOR SEWAGE DISPOSAL SYSTEM Putnam Va116y
Town or village
,�.. __ ;..: _:._:...= -� McTyi.� aw.r - .. �,.r . '!C. :.... ... �- ._ .. . , . .'. .. .,,,_ t t —ate.: j,T:.:'.irr .:.�w v.:n ..ia.. -• .. ..
Located at (.�,.! t.a11G:T QD(Map 0j,
Owner Mr. 8i Mrs Henry.'tel esttno , Tax map'I.ot H 57 6ubd. a
Separate Sewerage System built by , Owner Address Partr dge Lane.
Consisting of ` 1 OOO.Gal. Septic Tank and
520 L.F. x.24" Width Trench
Other requirements None
Water Supply: Public Supply From
X Private Supply Drilled By Norman Mderson-Inc.
Address Putnam Valley, NY /1
Building Type Frame No. of Bedrooms ee Date Permit Issued 417178
Has Erosion Control Been Completed? Yes
I certify that the system(s) is listed.serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in'accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date 1 December 1978 Certified by x R.A.
Address R.D. 9, Fair St a Carmel NY 105f2 License No 29206
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 'y sage. 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 private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner of Health, :;�!ocatlon, modification or change Is necessary.
Date By ' Title `�
Mr. & Mrs." Henry CeTesti'no Putnam Va71ey
Owner or PurcHaser oT Building Municipality
Owner
Building Constructed by
Partridge Lane
Location - Street
Frame
Building Type
Putnam Acres Subd., Section B
Section
Block
57
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 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 of Environmental Health Ser-
''- Sri !� !'if .Z •.,.�' r. 'ri i'yTj7 C1 ,.He-a.i �t;�'1 v„ r(�� }'1 t:, 't ?, o f '�..r the*
_.
l� -_ - s. Ta .e �P. is 1L .r lr!1P,
failure of the system to operate was caused by the willful or negligent
act.of the occupant of the building utilizing the system.
J /2
Dated this 30th day of September 1978 Signat
Title
If corporation, 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
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING • CARMEL, NEW YORK
1 r�'IF: nrl ,hrrE to n1, �'a iao I♦ rin...
This rc;,p,,. is tO bf.._ CG.rylpleted,b1 Weld : _. a vi �ed Cc r J • tljth <, ,t:.LFt."
:...':,.r••�•....,.�,tr.. -a �a`vtr: •w:%r e.q -.�: wl+r.•. .. . a
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
OWNER
NAME
616-(,CSTINC1 N6-10 41
ADDRESS
Piqq-rg,d(, C Ljv Pu-Tiol9M MU �
LOCATION
OF WELL
(No. 6 S at �p
(Tow /n)
(Lot Number)
PROPOSED
USE OF
WELL
(('
( DOMESTIC
11 SUPP Y
BUSINESS
❑ ESTABLISHMENT
El INDUSTRIAL
❑ FARM
❑ CONDITIONING
fn TEST WELL
❑ (S(Specify)
DRILLING
EQUIPMENT
11 ROTARY
COMPRESSED
® AIR PERCUSSION
El PERCUSSION
❑ OTHER
CASING
DETAILS
LENGTH (test)
I
DIAMETER (inches)
r; r�
WEIGHT PER FOOT
1 U
R THREADED ❑ WELDED
1 5 O
YES ❑ NO
WAS
k
CASING
YES
Intl ED?
NO
YIELD
TEST
❑ BAILED
HOURS
❑ PUMPED COMPRESSED AIR -2
G.P.M.
94'
YIELD (G.P.M.)
""�
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC(Speclfyteet)
DURING YIELD TEST [feet)
Depth of Completed Well r
in feet below Land surface: ` 7p
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
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLE ED
DATE OF REPORT
WELL LER (Signat )
.y.
7 YORKTOWN MEDICAL LABORATORY INC.
> > _r1 .i
o "We Ae'uGii 11 h ig, i is W.V. .16 5's #11456 245-3203
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED
Ho CELESTINO 11/21/78
CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE REPORTED
RD#3 PARTRIDGE LANE PUTNAM VALLEY9 Nato 11L24118
SAMPLING POINT
TELL
BACT8RIA PER ML. (Agar plate count at 350 C).
8
COLIFORM. GROUP (Most probable No. /100ml.)
0 MPT
HARDNESS, TOTAL - ppm
DETERGENTS - • Mg
NITRATES (as N) - Mg /L
IRON, TOTAL - Mg /L
AMMUN1A c extE (as N W mg /L
These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected.
A. H. PADOVANI, M. T. (ASCP)
so
t PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. '10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley
'_F�G�;e_ •. 7^,7 Town tx... ;!!a e
s:.`Ac�:.i + "r_":. m.'." -^:< = iv"(;' '�^i`'. tSC�i"l: i �Gv��'s`•'+%ai�; =5 :3'i ::. `e �:L•: :'n +�•�a.ati %�+nsam o Ma
..�5'i�'
Cuca ed' at X P
Block
Subdivision Putnam Acres Lot 57 Job 501801
Owner
Mr. & Mrs. Henry Celestino Address Partridge Lane Building Type Frame rame Lot Area 1 A. Putnam Valley, NY'110579
Number of Bedrooms Three Design Flow 600 Gal. Total Habitable Space 1 420 on I" Fl. Square Feet
Separate Sewerage System to consist of 1000 Gal. Septic Tank and 504 L.F. x 24" Width Trench.
To be constructed by ? Address
Water Supply:
X
Other Requirements
Public Supply From
Private Supply to be drilled by
Address
None
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o ons e AMR!
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance with the Bards, rules and regulaTrons of the Putnam
County Department of Health.
Date 1.0 April 1978: signed � P. E. X R.A.
Address R.D..9, fair Stre Carmel NY 10 12 License No. 29206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Com sio r of Health. Any change or alteration of construction
requires a new mil. A proved f disposal of domestic ni s �nd/or t we ly oaly.
Oate By �. -G9 b� Title
.. � .... »...- _.,�,. � = -�• ..• .,-.. ....�; - ....... _ , .... �....:..,. .- ........., a .. _ � , .. - .. .... .....� ..... .. ....., , , � . - ...,., .......... _ ....- .................. u �........ -'�
Gentlemen.-
PUTNAM COUNTY -DtPARTNENT OF HEALTH
x+
N•
Date 7 April' 1978
I
Re: Property of Henry Celestino
Located at Partridge.�.Lane,- T...
of Put. krmock Lot 57
Filed Map #815A
This letter is to authorize H. Prentiss, P.E.
a duly licensed professional engineer XX or registered architect
(Indicate)
to apply fo.r 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
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
with �Ii- 5i6visions of Article 1..- 45 or
8Y8 tbft -oii
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
ersi le
" P-E`� .29206
., # 29206,
R. D. 9, Fair Street' jj-V-
Address
Carmel ,'NY 1-0512
914-878-6170
Telephone
Very yours,
truly rp
v 'J""5 9
Y
Signed
Own of Pr6perty
artri e Lane
fEs 101%q4 Putnam VAlley, NY 105Z9 Fy P . R Address-
914-826-2830
Telephone
4C
Of THE Njt0k
, I
TEST P.-FT JY.TA REQUIR.P-1) '.V0 PT: 1-!.Y9'JT APPJ,,TCA'T10N
DEMMIIJIMIJ 011�1 IT' HOLE"')
T"%"nmT-T TInT 1 11Th TT hl 1:1 ,,„1 "N
30
36 .41
4211
48 Rik
54 if
I F. CA j r2
6011
66"
41-
7811
84
d
INDICATE LEVEL A GROUED dA TER C4lr ITEIC'D A @A C
INDICATE LEVEL TO WIUCH WATER aAFEL RISES AFTER PEJING ENCOUN'T'ERED A%
TESTS MADE
g 7rj ar--ps d§,V- Rr.Date f4og
Soil Rate Usedl
JzLo min/l "Drop: S.D. Usable Area Provided ORW,@
No. of Bedrooms 7AqoZ_ Septic Tanic Capacity Iddo Gals. Type Raffm evey
Absorption- Area Provided By_rp4--L.V.x211" 6 width trench.
Other
ivame _ . John H. Prentiss, P-F-
Address R.D. 9, Fair Street
Carm6l, NY 10512
THIS SPACE POP USE BY h-ZAUVH DEPARTMEi1T
Soil Rate Approved Sq. Ft/Cal.
b
VO 2
Sop ST —Da-te
Y
Date:
Insp.by
C ;7 :_
-a'.0
INFUALSITR 1113PECTIOT'
YC' .9
0
Comnicnts
,Proj?pr.t,y lines or corners found.
Can ostinatc., hou,-e location
Will driveway � need cut
Mu.,,A trees be removed --d-note these
Is deep hole representative O'f* entire SDS a*re a
Addit,ional deop holes n,--ed(-,d . . . . . .
DOA.)6-
Sufficient SW area available consider1nCD o,
driveway cut, house location, separation,.
distances., etc.
DEEP 1101B DATA
7
-Water- elevation:.
Rock elevation:
Soils descrj.,,)tion:
Ifate:
FINAL SITE IINISPEMIOAN Insp. by:
Hous- located where shoi-m on approved plan
SDS located vh-re approved . . . . .
. gnu th of tronch measured
Width of trench average
Slope of tile line•and trench acceptable
Room allowed for expansion trenches
ititil SDS' ar,M
.wirlecessarily graded
10 I+ t. m ' aintained from prop.line and
20 ft. from house
Separation of trench from house, well.
etc. follows plan .
Number-of bedrooms checks . . . . . . .
Stone,-,, brush, stu'llps., rubble) etc,,. greater
than 15 ft. from nearest trench . . . . . .
Z.
15 Ft. of peripheral soil horizontally from
trench . . . . . . . . .
Junction boxes properly set
CoWA surface run off froin drivoway., roads.,
ground surface, etc. channel. 1-10a-r SDS
area 0 0 * 6. 1. - 9-.� area 60i 6 0
Doe.: lot drainage a.1rear I ea SDS
FINAL GMING OF SITE ACCEPTABLE,
•
REVIEW CHECK ST T
//�:�b•..����,,�+i OlyY.V Vr •.A. .WSAa$ p•Yf .n^IU.0.:.'ia• a{i.. Y'.3 �$ � h. �..._� .H .« /
�!J�J V 1'lJl Y 1 S
House plans 0 o K.
Design data sheet
Peres presoaked?
!-in. 30" . pert test depth
Const. results for 3 runs
D. Hole log O.K.
Corporate Affidavit for other than individual
Authorization for engineer
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps._
Meets Std.
I;-,TAILS
if change is proposed.,)
Existing contours shown show new contours) 9
Slopes for driveway cuts, etc. shown
Mater service line location
Footing drain, etc. location
Top slope, bottom slope of fill
Percolation tests and deep test pit location c/—
Septic tank size and conformance to std. i-
3.B <R. house minimum ;
House setback shown j
Distribution box ftg. below frost
All water within 50 ft. of PL shown �.
Plan and profile SDS__�c_
_nthrPn' ?Jr?_ ^�.C.�ai?�s
..c�os��•- �GG� �••
'shown or reference made !Y
Property boundaries (metes and bounds- clearly shown
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P. L.
20" to Foundation walls
I00' to Nearest well
U0' to stream, march, lake, etc. incl
5' to Curtain drain
10' to water line (pits -20
15' to storm drain
10''to large trees
10' from foundation to septic tank
5' to pipe from leader drain &.foo ln)
.expansion)i
n� -�
Remarks
•fit•
i Oireb'y $uri7syAi rZu�#s�a bet6vl�
tructurp ioc4fe'il trom�aury
r i l i eN _k+coi d S'y Stirvey�ls sirrve.y ^,,,t
W$it•d>riit0rs rap4,
µ' "'' ---- -- -- Ef:gineera' -Me'l iemisrrta; J' _
4 , r r
Tcr , k; rC,rrs'-ptla, gpll® ►rest jntero.ls t'gzared >;by Cori ?.r.actar -J
Co mspec lire by, •HeOtth dept ❑ _ i tl _
° '
Ing
,NOTES }
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"1 M E N. S 10
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t.
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(� A E
APPROVI
A N z 3� _'_8 H.''- 22
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Gt 1971
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