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03567
.
{3 PUTNAM COUNTY DEPARTMENT i OF HEALTH
I Division of Environmental Health Services; Carmel, N. Y.. 10512
j�uin/.aM ;44LL -j
,...,...CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR. SEWAGE - DISPOSAL
SYSTEM. o.F / �!
.�,r,•�-: o :rte : �.�.r+e. .�...•++er..�:v..- a�..�..:.r -, ..v.►.•:.. -.•s: - 'a:vr.-�r �:- "..(',.,�. %L�. :%�NYft''tl°'.i� ill. °y� ..M.►:�..6�,w:�.,.
,o kVOt,70 �i QED% Tax Map J°� - — Block 3
Located at _
Owner /e <:FoAzzy' -/E 4— Lot / In Job
Separate Sewerage System built by ".%,(*/,/ 61-1-645:R. r Address (/,S 0,4
Consisting of � -Oal. Septic Tank and �+-ANC y�
Other requirements J� 's � /N oel'd 1541V10 G/Q�i �%EL .7. d ee -
Water Supply:
Public Supply From —
�rivate Supply Drilled By
Address a' -
Building Type / '0��T /�
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving the above premises were cons
attached), and in accordance with the standards, rules and regulations,
Date -/ 12-1-1-17
Address �-
Certif
Any person occupying premises served by the above system($) shall
conditions resulting from such usage. Approval of the separate se
available and the approval of the private water supply shall become n
subject to modification or change when, In the judgment of the Co
Date r By—
JWN
No, of Bedrooms —5 Date Permit Issued
n on the plans of the completed work (copies of which are
k*,Issussf by thg!�butnam County Department of Health.
1
P.E. R.A.
r
License No. 2 1�
as ay necessary to secure the correction of any unsanitary
ne I d void as as a public sanitary sewer becomes
Ib c or suppl comes available. Such approvals• are
ovation, e- is.necessary.
Title
RiKI -OWN- M-lCAC ABORATORY INC.
Yorktown Heights, N.Y. 10598 P.O. Box 99 321 Kear Street
RESULTS OF EXAMINATION OF WATER
:1TY, VILLAGE, TOWN 6 /OR N
3ACTERIA PER Iv1L (Agar
)ETERGENTS - Mg
kMVIO N A. r EF
AME OF SUPPLY
STREErP MAHOPAC N.Y. 1C
count at 35 C). COLIFORM, GROUP (Ma
M. RATES (as N) -jag
I,
--S N 0 mg
hese results indicate that the water was YES
DATE
1 1 1
AL - lag
-a:'9 I•L.. � r
- ppm
245 -3203
of a satisiacto it' ) " "'"
.. �i'Y, "' 'Ji�ty3 whe t e sample was collected.
t 1 •: n I Y
DEPT. OF HEALTH
A. H. PADOVPINI, M, T. (ASCP)
'.r.
'F
a PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512 {
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
-.. '•.L •B�Ets?.:a,at; ' US rivL`iF Ar ��' . :� :. ,;,,:. -v.. y�v _ _ _ _ _ ::.rt -: w
�% �e j tcr2f ..fit✓ E`It % illrEJ'����
Subdivision _T
Owner
Town or V5 lage
i
Lot f/° Job
Address
Building Type Lot Area 3z III
Number of Bedrooms 3- Design Flow p Total Habitable Space ' K- �.f /�� g Sq'uacre Feet
Separate Sewerage System to consist of / s,^ �` Gal. Septic Tank and
_tf'. !�c�' / °�
To be constructed by • ° 9L�ryr��� Address
Water Supply:
Public Supply From .
�rivate Supply to be
Other Requirements
led by
I represent that I am wholly and completely responsible for
above described will be constructed as shown on the appro
County Department of Health, and that on completio
be submitted to the Department, and a written guar
place in good operating condition any part of said
ance of the approval of the Certificate of Cons n or
will be located as shown on the approved plan and that i ell
County Department of Health.
Date :y""
Address _2t' &-
APPROVED FOR CONSTRUCTION; This approval expires o
revocable for cause or may be amended or modified when consid e
requires a new permit. Approved for disposal of domestic nit y
Date A® By
n q
'. J j
kproposed system(s); 1) that the separate sewage disposal system
ccordance with the standards, rules an regu a ons o e u nam ction Compliance" satisfactory to the Commissioner of Health will
his successors, heirs or assigns by the builder, that said builder will period;of two (2) years immediately following the date of the issu tem or any repairs thereto; 2) that the drilled well described above nce with the standards, rules and regu aTrons of the Putnam
P. E. ±--w.OR.A. {
X License No. 7 - '
a issud4 unless construction of the building has been undertaken and is,
the Com ner of Health. Any change or alteration of construction
or ►iv e w upply only.
- Title
J
7 1.
02 PUTNAM COUNTY DEPARTMENT OF HEALTH_
�,l... .. _. .._. vision: of nvir
•Di E onmen 'H ' th -.S� .zea= frrsP'• '�: �0"'7�` -.
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM 7-5t„v 04" PurlYAm V144i ey \
Town or Village
Located ' at Woo 9 - 6—i -ee' r
r� 9 Tax Map �+ Z Block 73
Subdivision Le// i f)2:c a 12i �, �� Lot O °1�1Z JobC
Owner- `Tc- R Go a0 iAdruz Address 3558 , �an�S S`I . J1�i2u73ytiK IV. 7. IQ
Building Type 120-51 D c 1gri (A` Lot Area
Number of Bedrooms Design Flow Total Habitable Space �f :C" Square Feet
Separate Sewerage System to consist of �n Gal. Septic Tank and 4Z 1 L!r"! 7i O 24°r %jZCr(Cfl +
To be constructed by
Water Supply: / Public Supply From
Private Supply to be drilled by
Address PUT-NA
Other Requirements - K ijIV - ()F -
I represent that I am wholly and completely respon
above described will be constructed as shown on the
County Department of Health, and that on com
be submitted to the Department, and a writt
place in good operating condition any part
ance of the approval of the Certificate of
will be located as shown on the approved plan
County Department of Health.
Date JuLy .2z. 19�Z
Address 0
APPROVED FOR CONSTRUCTION: This app;
revocable for cause or may be amended or modifie
requires a new permit. Approved for disposal of
Address
location of the proposed system(s); 1) that the separate sewage disposal system
,hereand in accordance with the standards, rules an regu a ons o e u nam
to
Construction Compliance" satisfactory to the Commissioner of Healthwill
owner, his successors, heirs or assigns by the builder, that said builder will
ng the period of two (2) years immediately following the date of the Issu= nal system or any repairs thereto; 2) that the drilled well described above
ccordance WM thedards, rules and regula�Tons pf the Putnam
P. E. R.A.
License No. 32 7 Z 0
" date issued unless construction of the building has been undertaken and is
b the Co mission of Health. Any change or alteration of construction
d/o + tow sup .
^
' - - -
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
pivision .of -•- Environmental, Health Sarvices
r 6 COUNTY OFFICE BUILDING - CARMEL,,NEW YORK
This ikport fs to be completed by will driller and su!•'.:4ted to County Health De)wtment together with laboratory report of
analysis of..water sample indicating yiater is of satisfact_or;r bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUWAITTED WITHIN 30 DAYS OF V ELL COMPLETION T
DEPTH FCOM IANI SURFACE Sketch exact location of well with distances, to at least
�
4. __ FORMATION DESCRIPTION two permanent landmarks.
_1.. -- - - -...-
WE
If yield was tested of different depths during drilling, list below
FEET r GALLONS PER MINUTE
18771 li
WELL DRILLEn (Signature)
NAME
ADDRESS
OWNER
/ 6 r
••
y
(No. 6 Street)
(Town)
(Lot Number)
LOCATION
OF WELL
.
or
NE
D
D
PROPOSED
DOMESTIC
ESTABLISHMENT
FARM-
TEST WELL
USE OF
WELL
CONDITIONING
OTHER
)
SUPPLY
INDUSTRIAL
DRILLING
�j
D COMPRESSED
❑ CABLE
a OTHER
EQUIPMENT
l�il ROTARY
AIR PERCUSSION
PERCUSSION
(Specify)
CASING
LENGTH (feet)
I DIAMETER(inches)
WEIGHT PER FOOT
[I
DR VE SHO
DYES ❑ NO
WAS A NG G >0 ?
Mz
YES ❑ NO
DETAILS
THREADED. WELDED
HOURS
G.PJA. YIELD (O.P.M.)
YIELD
BAILED
PUMPED COMPRESSED AIR
TEST
MEASURE FROM LAND SURFACE— STATIC(SpeCity feet) DURING YIELD TEST (leett
DcA of Comple'od Well
WATER
LEVEL
in feet below Land surface:
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (inches)
1F GRAVEL
Diameter of well including
GRAVEL SIZE (inches)
FROM (feet)
10 (feet)
PACKED:
gravel pock (inches):
DEPTH FCOM IANI SURFACE Sketch exact location of well with distances, to at least
�
4. __ FORMATION DESCRIPTION two permanent landmarks.
_1.. -- - - -...-
WE
If yield was tested of different depths during drilling, list below
FEET r GALLONS PER MINUTE
18771 li
WELL DRILLEn (Signature)
S
weer "or' u-rch&ser or uild ng Municipality
gu- f n-iw__Ons true tEd by ~
ooa�i
on —Stree B oc
WuMdlng Type of
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 b®ax,
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-
sorp, 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 util.iz-44:ig the system.
The undersigned further agrees to accept as conclusive the de,
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the cyst
Tbd iris -,' f __ii
�
19 1-81
Title
corporation, give name
rV�t and address)
- - . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - T A
THREE (3) COPIES ARE RE4UIRED WITH THREE (3) COPIES OF-FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS RERE�qjHZD TO FILE QT; CE 2F DATE OF F RST USE OF SYSTEM. .
- - - - - - - - - - - - - - - - - - -• - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of H6 910L
In
PUTNAM COUNTY f)f PART,*,fFNT Cr Ifl?Aull
DTVT.STn%, Cr. P %. VTRO%';•1F\TAr, 11FALTlf SFRVECF.S
Date J u 'Y 'Z "Z I `i rz (7
— 1
Re:. Property o (6, aLo "N ,cF-R
Located at WooA $–,Z ezr r of Vql Le
4eeti-gh— Block `� Lot.
Gentlemen:
This letter is to authorize STANLEY J. UNDER'_
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
connection with this matter and to supervise the construction of said . -
system or systems in conformity with the provisions.of Article 14S or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
P.E., n Zl Vic)
AM
ss DVA 4109
AMA %V" M. V. 10501
Telephone
Very trul y urs,
Signed
Owner of Property
Address / ®S
®' lephone
i") . 'FIL-L,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES �f />A1
"'COUNTY" `OFFrICE BUILDING; "C�i N1EL,` N . Y: ,10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner ��- Address 0,
a� T��
Located at (Street Adicate � �.-�_ . fv Block Lot P/o 4 -1
nearest cross street)
Municipality 4 r ILUAJ, Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to WAEer 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
1 17-/), % / rl1- c'l tip •� °Z -
5
2
4
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.
2
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. HOLE NO. HOLE NO.
• __ "'
G.L.
6►'
12"
18"
2411
30'►
36
42"
48"
54 it
601
66"
721
781
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
DESIGN
:.. -
_ _.�_. •Soil- ••Rate-. °TIj.�SCd_.. '�iil�1��17t''UrJ: � , ° -�S:Do� Usable'Area "Provided .�` . °... . ° �- ._.:..._
No. of Bedrooms Septic Tank Capacity Gals.
Absorption Area Prov By L.F.x24
Address D
Type
width trench.
Other
THIS SPACE FOR USE BY HEALTH DEPAR E "+
Soil Rate Approved Sq. Ft /G c "by Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE'BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner a Eg- rop_ , Auk 0,4V- IJ� f 0568 .#
x H,*P-
Located at (Street 4dicate �dn? fo"d Block Lot P%v L�
nearest cross street)
Municipality:Eo�%/,*j D� i` U't'JjAbaLp k,"j Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK
TIME
PERCOLATION
PERCOLATION
Elapse
Depth to a er Water ve
No.
Start -Stop
Time
Min.
From Ground Surface in Inches
Start Stop Drop in
Inches Inches Inches
Soil Rate
Min. /in drop
P)
17
2
=¢�-- �'�'
17 154- I 4_
1 -1
- ,1.7_�
JI -d
--�—
2�/, /0 -4 ,
3.2 J3 24.3 34' /. f of 2=
4
5
2
Notes: 1) TeAts to be repeated dt -same deptn until app roximatel,y,lec�ual 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
r n
Tr c r T r m
�O._.1�, , '� ��?C.f)._INT,I�Ri�D Tn <_ . T_ F�_L,:.:HQI,FS
xEp 406!6 1
DEPTH HOLE NO. , PP HOLE NO. HOLE NO.
G.L. aPS iU pS o�G To oiL l��Sc�it
6 i ti
1211 F 0A ill
1811
2411 4
3011
3611
i
4211 �
4811 a
51� 1 if a
6`0
6611
721f 1 �%
781f m W
8411
TNDTQATE : LEVEL AT WHICH GROUND WATER, IS E'.V_ C OUN T ERED
.INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED7,j
:TESTS MADE BY _ - Z Date 610-77
DESIGN D1
Soil Rate Used de, Min,/111Drop: S.D. Usable Area Provided eT
No. of Bedrooms Sept c Tank Capacity j 8�?> Gals. Type %"r�c� L�+�c.
Absorption Area Provided By �'L.F.x2411 a�3 width trench.
RTI �o .AND Other
Name "' na ure >
, \kAddress A Y, 10501 �, L
THIS SPACE FOR USE BY HEALTH DARTP
Soil Rate Approved Sq