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BOX 28
I oil 019
ma
ol
' : _ 1 1� %% '�� y� 1 L T
Private �Suppiy Drilled !+ey
Address
^Bwldin9 Type �.'"
:,;•Has Erosion -Control' Been'',Completed?
I'cer'tify that th'dsystem(s) as listed serving the above premi!
4, .attached) and in accordance with the .standards '.rules ani
r $
a
1 ,. -fir-._ � V' t ♦%'
Address p "
c �? r
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Any person occupying premises served by the above syster
ponditigns?,resu'Iting: fiOm'- ch' usage;:. Approval)r
R
SY 1 Eiili ��6t1i1.1 n/C / "ids A_
-Town or. Village
lineal Feet °':X t ` width trench -
:.,
,ms ','Date. Issued
F.- -
n the plans of the completed, work (copies of which are
ed b'y •Yhe utnain' County;;:Departnient of Hea'Ith.,. f
p.E.:'- R.A. . I
ice nse�No..3Z720 I
cessary ta'secure the correction ofcany,•unsenitary.'
fj 11
"pi, d, as soon as .',a public sanitary sewer becomes
water -:Iy becomes available.'- - Such approvals are
it ch re het m�odif icition or change is necessary.
�f �, � , Tale•` � �
Ai.v :si,on of Envir_omdnt.al Health ;Services., Putnam County Departrhen.t -of ] >"lth
"
..� .� K. ..w �. ±ter Ma. .. . vit. .+u. -tti .. .s•�. -M'V ... �.... —w. _.. .....,;_1 A.,.:
Owner or Furctiaser o Building Municipality
Zjfw/,r4, ; eecr, &%./ - &
BuildingVConstructed by It
Location - Street
94.
Building Type
Block
�J
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 trade by me to' such s -Nrstem, 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-
...�vi ice s••-oI .•the...'P .imam : :Ga �y • D•ep.a- rtaien�. c•I: HP.a�th, -a:s- to -wht •t•h:e =r.' Z.r._"Ao t... :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 Hfl''/ 19,7f� Signature �°-•.
Title
f�Qv� (If corporation, give name
and address)
w4i 'kPIA`fr�- A•- ---------- - - - - --
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
4768
YORKTOWN MEDICAL LABORATORY INC.
P.O. Box 99 321. Kew Street
Yo kbe�wr Heights,., N " 1Q598 -- : t 245-3203
DATE COLLECTED
.RESULTS OF EXAMINATION OF WATER 5f7fZ5
.,.,..�.. - — - - -- -- ti
BOTTLING GREEN DEVELOPMENT CORP.
CITY, VILLAGE, TOWN & /OR.NAME OF SUPPLY DATE REPORTED
EAST HARTSDALE AVE. TSDALE 8
,,.AMPLING POINT
MAD_'RAI?r'_V? Cm k '=TnT.V IDAmu rr1TTDrP DTTMKTAM iTAT.T.Ti'V AT V
BACTERIA PER ML, (Agar plate count at 35, Q.
COLIFORM. GROUP (Mostr probable No, 100m1.
RDNESS; TOTAL -ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
–FR—ON, TOTAL - ppm.
FLOURIDE (F) - mg. /1.
These results-indic¢te that the water was YES of a satisfactory sanitary quality when tl
<M MEMBRANE FILTER TECHNIQUE
I
so
L'
TOWN OF PUTNAM VALLEY
WLLL DRILLERS LOG AND REPORT
WELL DOCATION
street section b ock lot
WELL OWNER
name ad ress .city or town
J
WELL DRILLER ,.C,.r„, 3
name address city 00 town ;of'y�
WING DETAI YIELD--TEST ATER E DETAI S
ai ed easure from d surface
Jengh: feet or
Pumped -His.. Static —ft Make:
en ai e of
)iameter: Inches Yield: G GPM Dr Pum ed ft Len th... Ft ize.
Cind: Diameter In.
i'AL DEPTH OF WELL e e t
)epth From 'Give description o formation penetrated, such as: peat,
7round Surface 'silt, sand, gravel,-clay, hardpan, shale,,sandstone,
granite, etc. Include size of gravel(diameter and sand
(fine, medium,.course), color_of; material, structure
(L&o -se; packcd;�-cemehtes, -so t-,--haz= d-j:i`Lx: fit. to-2'7 Wit:
fine acked ellow sand 27 ft to 1 4 ft graX granite)
;et'to 7eet tion Descri -ption ketch exact location of well to
/ at least two ermenant Landmarks
o
)ate Well Completed IZ 73 Date of Report _.
Well Driller_ _
signature
FIELD CTIECK LIST
4ev Date
7 r�
Irisp.by"
INIT "Ir,L SITE IP,SPECTION IYes � No � Comments
Prepzrty.lines or corners found . . .
Can estimate house location . . . . .
Till driveway need. cut . . . . . . .
Must trees be removed -note these
Is deep hole representative of entire SDS area
Additional deep holes needed. . . . . . .
'Sufficient SDS area available considering
driveway cut, house location, separation .
distances, etc.. . . . . . . . . . . . ..
DEEP HOLE DATA
LLpth: .
Water elevation.:
Rock elevation:
Soils description:
Date : /0 -.���_ 7
FIND , SITE IPISPECTION Insp. by:
House located where shown on approved plan
SDS located_ where a.ppro -Ted . . . ... s
Width of trench. average
Slop;; of the lire and t ,ench acceptable e
Room allowed for expansion trenches . . . .
Over 50 ft . from swamp, watercoiu�se
Tvd t v 'al S`G11 °i1�\� li" a7t_L
_'d- or SDS a rE'a _
urmecessarily graded . . . . . ... .
Al 10 Ft. maintained from prop.line and
20 ft. from house . . . . . .
Separation of trench from house, well
etc. follows plan . . . . . . . . . .
Number of bedrooms checks . . . . .
Stories, brush, stumps, rubble, etc. greater
than 15 ft. from nearest trench . . . . . .
15 Ft. of peripheral soil horizontally from
trench. . . . ... . . . . . . . . . .
Junction boxes properly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS, . .
area. . . . . . . . . . . .
Does lot drainage aDDear O.I. in area of SDS
FINA..L GRADING OF SITE ACCEPTABLE
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PUTNAM COUNTY DEPARTMENT OF HEALTH
{ DionEmHealth Services Carme/ N. Y 10512 o
ri
CONST:UCTIO�V .P.ERMIT,FORMSEWAGE DISPOSALSY.. PW., STEMii§'"_ •.'Sri =%t,
i
Ta wn.or Village:
LoeateC °at 7. ,li265 � � ► ., • n + Block i T
Subdrvisio "n) "' L� c Vii' ' Lot Joe�b�y r-, `
kOwner ' Address f' �itC a<� cry s "�1Y d Ti>t �"� Ago, eAL
01. -7 _
Building Type ` { Lqt "Area'F,: 72 a /V • ` `o> L�•L7 = j�7 ! /'`=.
Number of Bedrooms " Total Habitable Space �' "LSSquare Feet
Separate Sewerage, System;. to c�o%n ;�st of - G_al Septw Tank Urieal feet - 4` width trench,
T,o be constructed byswt� s��p ;apd c Address t '� ►
� r 1
1
VYater Supply Public Supply From
rivate SuPPIy to be drnad by, i������h�•. a
•
Address 6'Z
w
k .pr • {_'
Other•'Requirements t
('represent that I am wholly and.completely_responstble,, C n 'of 'the proposed system(s); 1) that the separate sewage .disposal system
' p n�rri he standards, rules an regu a ions o e _ Putnam
above described will be constructed as shown on the ,a ve nd�n accordance with t
County Department .of 'Health, ;;and that on comp) a''C'' onstruction Compliance'. satisfactor ',to the Commissioner of Health will
be submitted to the,Department; end a w "ritten ,' rn sh y neS his wccessors heirs or assigns, by •the builder, that said builder' will
place .in good operatin Conddion an rt of
-'
g y; ,pa g is" m the period of'two (2) years immediately following fhedate of the issu
ance.of .the approval of the .Certificate of Const n C r r �tcifjy' igi I system;or any'repairs ; thereto 2)'that;,the drilled .,well described.-above
will be; located as shown on.the approved plan and t d we X11 b91ih51 i ° ' ordance; with `t standards, rules and regu aT oi' ns of the. Putnam
¢ounty4Departmert of H�iealth MCrt -
6a �. °"> .'1t P. E. R.A.
5 Address ® a e _ License
PiPPROyED FOR CONSTRUCTIQN:- This approval expire _ ar a date :issued unless construction of the building has•bee� undertaken and is
revocable for cause_'or may. be a mended . or,modified;when cons) essary, by the Commisswner of Heal4ti,, 'Afly•change or, alteration of Construction
regwres"a` new per ' t `:.Approve`-, for.disposal of, domestic s— anitaar sawage, and r private water, :supply only., •�`
Date
rl
PUTNAM
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property o
Located at
xe�dl AVV 0444 pel Section
66
Gentlemen:
M
Date %?, 117'
This letter is to authorize
i•. ° ,` -21
Ai STANLEY I LANDED
a duly licensed professional engineer wl or registered architect
(Indicate-
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
Depar - ieiit of Heaitil, anu 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 145 or
147, Edui at -on- Law, • •the- :._PubldL ?ea:-ltk -law -ai=d th- e'.Pu�x�aM. Gounty . San '- _...:: - -_
tary Code.
r'
C ounce rs igne
P. E. P • I # 7Z
STANLEY J� LANDED (Seal)
A res� 2, 67
uh �� � �
5 e
f �
Very t
Signed
— Tee oTi ne- /
. I
FUTNAM- COUNTY DEPARTMENT ..UF HEALTH....... ... .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
re
Owner . O 41AIc 6 ,d i &,,& �r� " %Address � s�
Located at r Street � f °
ec. 6� Block :S� Lotj
Indicate neares cross s ree
Municipality 47G+�,y cy - 4. L ILL e .E' Watershed kffi:�_r<&e WL-44.0e_f n
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH.APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
apse
Depth to
Water
Water Level
,
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
l 9
l.i
/6
f j-
L .`
2 91=/ 7
—9-:2- i
3 � -_2,r
j !/
17
.. ��
�•
in
4
5
1
2
3
4
Notes: 1) Tuts to be repeated at same deptn.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.
�fI
r
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
. -:. ,.ri DESCRTU1%T- 01,-" SOIL",- MMOUN` -M-ERD -IN: TEST;-HOERS: •. _,..:� _ ....
DEPTH HOLE NO. P/ HOLE NO. �`'l HOLE NO. - 4 E
G. L. '-1 a .;ro / f-
6" i
12" n
18 "�
2411 1�
30 #
36"
42"
T
L'
,�j j 4--
a�
48"
54 �
60"
66" y
72"
7811
8411 �
INDICATE LEVEL AT WHICH GROUND WATER IS- EPZGOUNTEREp �? _ e14, 1
INDICATE LEVEL TO�lnflllCH W. TER LEVEL RISES AFTER BEING ENCOUNTERED
`' TESTS MADE BY -5 Z % Date y l
DESIGN
,Soil Rate Used �Min/l "Drop: S. D. Usable Area Provided dw0
No. of Bedrooms Septic Tank Capacity 900 Gals. Type /`mac. Tic
Absorption Area Pro ded By__L.F.x24"width . trench.
Other A
Addres
THIS SPACE FOR USE BY HEALTH
Soil Rate Approved Sq.4ft0 �3ed by Date
tv
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"it it Ihorevy "alfiNj Thal tmesurvey
wse v,apared In accordance ti~ith the
ovistfing Code of Practice for Land
&,ur "All certificatic.7IS hereon kir;'valid for the map and
�dya adopted by If. Plew'rork State
Zofessjonal Land Surveyorn;P
046flan of Copies thereof only if said map or copies bear the'
ifflpre!ssqd seal of the survoyolt whose -zignatuve appears
SURVEYED @ PREPARED BY
BUNNEY ASSOCIATES
AS SHOAVAl ON ",5V,,5d!5;y VISIOAl
'P OF SECT /orV A' GLOCA/y1oRR.9
/A/ TfIE
cz
4447,qCI-1 06, 1971 AS /)1`X?,` /V-?
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15M1Z?v1f1k1 OV:,_
OF AWM#q" 11M.4 E-*y
/V7 covNry
50' 1YA4?C1-1 /2, /973
ENGINEERS &.SURVEYORS •
W W000_5101q1101v__ 1AV10. 929 MAIN STREET--'
-ATONAH . NEW YORK 10536 PEEKSKILL, NEW YOR#6,_=�
—,A/ �24— V 0,Z11WEA7_ COZ?,47
V_
SURVEYED AS IN POSSESSION PILE N,9.7-838-1
M. Y. S.L.11C.-No. 284194 A'08
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