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03548
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(� f f PUTNAM COUNTY DEPARTMENT OF HEALTH"
3 ',1Z C ^ Division of Environmental Health Services, Carmel, N. Y. 10512
� ?��ICA� -- F. CnMSTgt)C
.1 St _SYST.EM ,. - P.ij 'I 9 P.
Town or V''la' e`
Located at Boswell Road Tax Map Block
Owner
Thomas Marshner Lot 36 Job
Separate Sewerage System built by ((�� Roger Heady Address
Consisting of 1, 0 0 gal. Septic Tank and 3181 of 3' trench
Other requirements Pump and 550 g a l. pump pit
Water Supply: Public Supply From
X Private Supply Drilled By Norman Anderson
Address
Building Type
n c h No, of Bedrooms-
Has 3 Date Permit Issued 1/9/76
Erosion Control Been Completed? Yes
I certify that the system(s) as listed serving the above premises were constructed essentially hown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, an a permit ed b he Putnam County Department of Health.
Date
812/79 Certified b- P,E.X R.A.
Address
Route 52, Carmel, N.Y- License No 043880
. ,
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 usage. 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 ofMtom ssio ne f Healt ch revocation, motlifiwtion or change Is necessary.
Date ` Ti le
jj r e
- j to �.. S t o >)tl�r ra, 404
No rQr-o (,J off' �i`n a rin J I a irlal�`Pi � �' ' , -t1' (' 4 (9a
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y, 10512
' k!i(AuCil iti�d FERIVii 'FOR' 'SevvHGt DISPOSAL Sir`S7 IV1
Town or 1 e
Located at Section
Block
Subdivision Lot
Job �—
Owner N _01 Address
Building
Number of Bedrooms
Lot Area
Separate Sewerage System to consist of Gal. Septic Tank
To be constructed by �-
Water Supply: Public Supply From
Private Supply to be drilled by
Add
Other Requirements
Total Habitable Space Square Feet
.V,
C� d /
lineal feet X 3`.`- width trench
Address
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 regu a ons o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
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 the date 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 ' Baccordance with the standards, rules and regu a ons of the 'Putnam
County artmenntt of Health.
Date r 0 • �'" _.- -) / 1,;...i //- --�r/ �•�a 1/
-r - - P.E.—_
Address License No,
APPROVED FOR CONSTRUCTION: Th .approval expires one year from the date issued unless constr on of the building has been 6nc�:
revocable for .cause or may be amended or modified when considered necessar by the Commissio o ealth, Any Change or alteration,
requires a new permit. Approved for disposal of domestic san' ew a d riv e w er
�-_ ? 6 .
Date By
Title _,�s� •
e
X3708
PEEKSKILL ANALYTICAL LABORATORY
201 Butionwood Avenue
(Corner of 202,. across from Hospital) "
Peekskill, N. Y.:10566 737 -8777
DATE COLLECTED.
RESULTS OF EXAMINATION OF (RATER 7/I6/ ?9
VNER .: DATE RECEIVED ....,.. —
mionla.s M&rschner 7/16/79:
TY, VILLAGE- TOWN & /OR NAME OF SUPPLY DATE REPORTED
Boswell Road,. Putnam Valleg; New York 10579 7/1.8/
tMPLING POINT
4CTERIA PER ML. (Agar plate count at 35 . C)
7
COLIFORM GROUP (Most probable No./100ml.).
Q ..�r
HARDNESS, TOTAL - ppm
3TERGENTS.-, mg /L
NITRATES (as N) = .mg /L
IRON, TOTAL -. mg/4
AMONIA, FREE (as N) -mg /L
.iese result indicate that the water was .Y4S .. of a satisfactory sanitary..quality when the sample was collected.
A. H. PADOVANI, M. T. SCP) `
WELL COMPLETION REPORT
3171
PUTNAM COUNTY DEPARTMENT OF,HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
ti.: � : - � rIAk�Sis, �f WraTEI►�.-$t3�1'i�!c Jl1i�IGa +!s1f3 -NJ�te =1 O!w,S ti f�G':E' ";��t^,_Ct(:h?! ' RltvEi "f'�.ri aC sZ:o3f ::'iii r-� (�r:iFi :� iS �i
•'...:,. , �::.. � � .. __ . -.. ,;:, .... % ,fY.. .�..,$.........�:' _�� -:.1, .n.8..4i.`..:.f3?,'„�.l J �... d- ._S43ldCi+Hid' i.., dnC;_:6S'., i:SP_ .t..".::xia'..
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Thomas Marshner
ADDRESS
Boswell Road, Putnam Valley
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Lot 36- Boswell Estates
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
11 SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ OTHER
(Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTHER (Specify)
CASING
DETAILS
LENGTH (feet)
9 4 1
DIAMETER (inches)
6 ii.
WEIGHT PER FOOT
Cx1 THREADED El WELDED
S O
YES
NO
CASING
YES
D?
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ® PUMPED ❑ COMPRESSED AIR 6
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE -STATIC (Spa clly feet)
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below land surface: 100,
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)'
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Incheal:
GRAVEL SIZE (Inches) FROM (feet) ' TO (test)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
See attached plan.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE 7LLIOMPLETED
DAT OF REPORT
r 177
W
e
e' a
Owner or urc aser of Building Municipality NX
7AA 06-'Q4
6 s 0 o.X
Building Constructed by Sebti.on
�W
AA ��
Location m Street Block
�p
Bui.l i.ng Type 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-
.: -_ vic_es of the Putnam ...Oounty_: - Department.- .of.;.Health_..as_vto --Y het-her-- or:�not` - :- he
'a�zr�e °cf' °tire -y°ai,C71i-'�U�'aeae",�as caiz's`ea'by'he willful or negligent
act of the occupant of the building utilizing the system.
Dated this day of 19�?q Signatu*r&�Iky
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
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GEORGE ' A. HAUGHNEY, P. E.
CONSULTING ENGINEER G�
OV E:
Route 52' Carmel, New York 1,05 3EPj! YA�tll 3,
a 717 is s WA
YiTLE SW V4 a, ' . %4.S 1.1 -7-
WA
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sa.-� �. �: :': C..° .�i :• +C_.V 4iT.'.�.. ... ..a ia. r. Y>. .... _,. +..... - _ _ .��..,..•.e.- p_,rr�w C.: .�r_..r w�.._ i�a -.. ..a _. ...... � w.....
-Ody/
Da to °
Aj
Re ° P�'operty of
Located
Section Block
.gentlemen:
This letter is to authorize George Haughney °
�"duly licensed professional engineer x ._
or registered architect
to apply fora Construction Fermi al e
fora separate s ecva cr'
ge. system; to
serve the above noted property in accordance with the standards
romula� rules or regulations as
P gated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on m
connection with this matter. and to supervise ^ +„ y behalf in
the eor.� �; uct; on� of said
system Or. systems in conformity with
147, Educ a i i o the provisions of article lc
�5 or
n --
-•
a-�J�. .
,tary Code,_ ...___. _.....� _.._. - _.._._.f,.- ar id,
very truly yours,
Signed_'
�����►�' caner of Property / �� -_-
•ountersiRned:
aivaress -- — /�� y
fti1 "r•, +s. CKS. s — \ /L°QSl%�I� //� / �F
JdresS
Route 52�' A()o p U......
Carmel, NeW/,4�►15► 1�T12
(914) 225 -9353
!lcnhone
j ti✓
delephone
Work - 737 -4400 'Ext..408
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NV
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
°` °(�� liyi'Y'`.f1rr I,"E''BU�Ii i ir,�VCARMEL � 1V. Y.: M10512 L
DESIGN DATA SHEETS SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner i%` Addresszmm Z/�
Located at (Street Sec. Block Lot _56
..'Indicate neares cross street)
Municipality 9 Watershed
SOIL PERCOLATION TEST DA A REQUIRED TO BE SUBMI ED WITH APPLICATIONS
Hole
Number TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to
Water
a er ve
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
/0.��
�,�
/4
4/ 9/ - I'S % 16 0 026
1
R
4
5'
1
2
3
4
5
Notes: 1) Tuts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO, _1 HOLE NO. HOLE NO.
10
611.
12"
1811
2411
3011
3611 4 ��ZdAz
4211
4811
5 4 it
60"
6611
7211
7811
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
DESIGN
-�Ide
Di Usable Area Pro
No. of Bedrooms 5 Septic Tank Capacity(200 Gals. - e Wee
Absorption Area Provided *2�L.F.x2411 b - A Tv-
ench.
RN
Name ZZC
Signature
Address EAL 1U
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft/Gal. Checked by Date
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