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03573
PUTNAM'- COUNTY DEPARTMENT OF HEALTH
7
DlViWoR.of Environmental Health Services, Carme% JV Y •,10512
_.._.: ,:£EFT9!FiCA7f,,E- OF..` L ONS'tAUCT�dT4 t (.�MP�.I.�eA�CLi OR GEWAf'¢,, " PL,
tnam °Valle" i II
Town
1_ocated•at Butterfly Lane�� Filed Map #1 °052alock
owner Mr.. & .Mrs . Vi ator Gale got 2 Job hS0654
Separate Sewerage System, built by Merrill .Pe:r.r.ault. Excavation Flddres5 Slienorock,`N Y "10587°
Consisting of 1.250 Gal. Septic Ta "nk 184 lineal Feet X 36 i nc6 ` 'width' trencFi -
a Fi 11 Section - 70' .W� de x 24' L' ong x 36" ` Deea~ (Cl can Fi 11, ,Not 'R -o -B)
�.
Other .re uirements
Water Supply: V Public'Supply From'
X ' Private Supply Drilled' BY Norman ;Anderson &` Son
Fidtl ►e55 Barger St ..,:'Putnam ValAey,. New York 10579
Frame Four.: /22/72
Building Type No of Bedrooms Date'Permit,Issued
Has Erosion Control Been Completed? None Req' d
I certify that the systems) as 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 r* e gulation3,�plans f11 and the permit issi b th'e Putnam County Departm!en of Health,
Date 11I9�./.,: Certified b I. . P. E. ^, R.A.
Address
R.D. 6; Box . 35 :_ C el ', New 'Yo; k 1 Ob12 License No:29206
Any person occupying premises.served by the above system(5) 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 es a public' sanitary sewer becomes
available and the approval of the private water supply shall become null, and void .when a public. water . supgly becomes available: Such approvals are
.subject formodification or change when, in the judgment -ofi the. Commis Health,,such reJoca ` modification or,change is 'Necessary. i
Date �� BY- . Title
so
I
I
Q �
I rt
STANDARDS
- - j CLINICAL AN D -ANALYTICAL LASO R_ -
ATORY,�NC.
_..�65 MAIN STREET _
NEW ROCHELLE, NEW YORK 10801
NE 6 -1400 November 1 1972
� h '
Victor Gale
Butterfly Ln
Putnam Valley PTY
REPORT OF jdAT R ANALYSIS
Received October 27th, sample of water.
Appearance: colorless, clear, odorless
No coliform organisms developp"ed in
48 hours of incubation.
T?1i s ,.rater is considered Su � table fcr
drinking, d
Respectfully submitted,
NEW 'YORK MDICAL LABORATORY
800 SHAMES DRIVE
WES URZY, I� EW YORK R1590
Dir ctor of the ab atory
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
-This Tepgq- Jr',to.:be.'c rnpleted_b .•wel!.40IRr. and., submitted to. Count�Health .Department togeth.er.with.I 'oratnry :rgport caf.
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 -
I/
ADDRESS
LOCATION
OF WEII
y (No. 8 Stre t) (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
D DOMESTIC ESTABLISHMENT FARM TEST WELL
11 SUPPLY a INDUSTRIAL ❑ AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE OTHER
❑ ROTARY �� AIR PERCUSSION ❑ PERCUSSION if
I )
DETAILS
LENGTH (feet)
,` r
DIAMETER (inches)
l r
WEIGHT PER FOOT ��jj
j L THREADED ❑WELDED
D I E SHOE
YES NO
CASING IiRO E ?
YES U NO —
YIELD
TEST
HOURS G.P.M.
El BAILED PUMPED Q' COMPRESSED AIR 7-/- _L0
YIELD (G.P.M.)
�2_ , 0
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST (feet)
Depth of Completed Well '` r
n feet below Land surface:
i 2
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 (lest)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
r
r
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL CO PLETED
DATE OF REPORT
WELL DRILLER (Sign Pure)
E�
r
F;rs. ictor 43? k
Owner or Purchaser or Building.
Building Constructed by
Location - Street
Fnxr,e
Building Type
Ptitnair, Valley
Municipality
Rrm?A, View Acres Sub,4,
Section
Filed t4an 1152
Block
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 bui.ld.ing utilizing 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 system.
Dated this day of (Dr-c-p 1.9 k Signature
Merri;d i errauit Excavado a Title >
P.O. Box 74. If corporation, give name
Shencrock, K. and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPjETION 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
PUTNAM C ox
b tvision
', of tn viron,
j
CONSTRUCTION PERMIT, FOR -SEWAGE, DIS06SO
7
Subdivision ft1-
hd View Acres 'Ubd`i
Aft & ., N
..-,Owner— Rr j ct6r:-'G04.
Building' TYPe - Lot Area.. ,
F
Number of Bedrooms 6ur
Y:':
��-s60ar6t6 ��ew'erdg�e'��s�em�' to 'Consist of
?
To -be constructed b
Water. Supply: 7—I.Public.Suppli-Frorif.
Private Supply to be drilied -by,_
Other ` -ctj V*
-6n -,6::Wtde'
.Requirembnts,, S16
-;.j.represept that i a�k� wliolly'and �completely r6ipon'slb
'a'biove—cle'scribed vvil'i be constructed -as shown on 'the appidvedl
a
':County 'Department *of Health;; :and thAt on�66mpieilcin'.i6eie
be submitted to'jhLb6part`m4hti_, a,nd. a..'Yiritte�',��6a'ririt�e
-Al .._1'11 , 1, 1 1-_ —Y
a t* saicl.*:kWiji`:
pp.. in -gpqg,�. opera inq.,qoq ition
I ':,ap0roVaI �Certificate " Cor)s,,!ur opp,"., � qi
9cS 9 190 of.,,t the 6 i t
will ibe,locatea assh_awn oiithe a'ppr6ved. plan and that said *61i
County 'Depar men of Health
Date 2/1
. 7
APPROVED -FOR, CONSTRUCTION: This 'approval,exoires-.6
Pr&6cable forcause or maybe amended o-r'-*m-o,'dii�,id -"w"heii.�c:6iii
S . ��'PprVved for domestic_ `
requires a, new ;permit' disposal of
-Date B
7,
"N TMENV V HEALTH
Weahh 'S66ice*;, 'C`/V. Y. '-.10512-
Putnam. NO I ey.
Town or
.7ma, e- —
:4
SMS4_, ,:-
AN
WAFA
ion _-
: q 4 the.,pr.op9sed system(s)" ly- that.the -separate sewage disposal system
ip ' and with the itandards, rules and re g
u lat io ns =qf t he PutnaFF
of Construction Compliance _ satisfactory to the Commissioner of Health will
the owner his uccessors Neirg:or,'asiigrii by ilie' builder; that. said I builde.r.will
A u`r'ing, �the `.,p,dri -'(2).!,yeariimme�diateiy 461lowing, the date of the iSSu-
original s ste
2 'th at ,��he doled well II de'scrib, id above
in Bards rules n ,r egUla onOf the P u nam"
P. E. R.A.
..New °Y. 51
�e 9206
T N
Ase No
date, lissued !";unless ' co'nitrddtio'n of the building has 'ti.een -urid6rtak6n: and:. Is
by:;ih,e,,'Cqmmis A change oe,aiteration of construction.
ea,ith. . "n y
�-:aha/6r - 'rivilte . w!a?ij 'SO rO.
ply:"o
Yitle��'
JIM
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,
Date 9 ML l�� T
Z
Re: Property o�x� . (/.? /P:7�M, Vd.C4=;_%11re 99a ta
Located at
Lot
Gentlemen:
Jo
17 hnn N, Pventi s I P,
.This letter is to authori In
a duly-licensed professional engineer 0 or registered architect
-
(IndicaTel
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
Department CO li_ a" t h I , and to sI gn all necu88ary 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.
•
ountersignjqd
P.E. R.A.,
RID. 61 1% 353
Address
Cayrnel, 14m, York UMS12, � Y
914-97S,4170'
Very truly yours
Signed
'Owner o Fro erty
/V p�s� 'yFF�
IV7pb
29 2
,
N Sl
E It
C$
T
I I
PUTNAM COUNTY DEPARTMENT OF HEALTH
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM
# f .
Owner
J&&&LAddress
Wfk* L
Located at (Street) &00 A. foc ot-
AA�
�Indlcate near e'St cross s,ree
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run- Elapse Dep Water Water Level
No. Time From Ground Surface in Inches Soil Rate
Start-Stop Min. Start Stop Drop in Min./i,p drop
Inches Inches Inches
I /old-
2,jQjd fail 7
3," /Q/ I mg 3 106P
, V-6
2
,A
1
Notes: 1) Te,qts 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.
V
MST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
T
_-DF19,C1R.T1'_T 0 0 i;,_- _1111-1ruliaf?F,11.Z 7
ZT_ L d
DEPTH HOLE NO. HOLE NO.`S HOLE
G.L.
611
1211
1811
24"
3011
36"
4211
4811
5411
6011
72,11
0
AT,WHICH GROUNI
INDICATE LEVEL "T6 Rf-ffClf IWAMR'
TESTS MADE BY
to
Soil,`,Jate Used e-M S!,D,,., Usable Area:';'�Prov`ldijd
_P �
No. of Bedrooms A,�Septic Tank Capacity 0 b4jf , Gals Type 11400*g
Absorption Area Provided BY- 4.0 L.F.x24" 5b width trench.
ier
ftssio/VA,
Name ou.-IF) 11. rMulsso r. t. ignature ii- -IV
F
Address R. Di 6 s 0. 353
Olmel, Zav) York 1512
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
b
29
Soil Rate Approved Sq. Ft/Cal. Checked b e