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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.11 -2 -20 BOX 29 03623 � all 9-1 is J aall� ', M' 4M I I -, �, a 6 JIM Me , i - al r 03623 e WELL COMPLETION REPORT 3/71 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 #.lL at—er sample indicating :a %titer is of satisfactoryba; ter ial wuaiity-before°crPti 'ica(6 6T_ consfruciiori'compllance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Robert Ne Stapleton I ADDRESS Wod Street RFD _Mahopac, NY LOCATION OF WELL (No. & Street) � (Town) (Lot Number) PROPOSED USE OF WELL DOMESTIC 11 SUPPLY ❑ E TABL SHMENT ❑ INDUSTRIAL FARM AIR CONDITIONING ❑ TEST WELL ❑ OTHER (Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION CABLE ❑ PERCUSSION ❑ ((Specify) CASING DETAILS LENGTH (feet) r DIAMETER(lnches) �� WEIGHT PER FOOT f Y`=' THREADED © WELDED P&LVE SHOE PSYES ❑ NO W CASING YES j UT ED? LJ NO YIELD T EST ❑ BAILED ❑ PUMPED El COMPRESSED AIR HOURS G.P.M. w YIELD (G.P.M.) WATER MEASURE FROM LAND SURFACE — STATIC(Speclfy feet) DURING YIELD TEST l feet) Depth of Completed Well �vVLEVEL in feet below Land surface: 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) i TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET .t If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL /COA PLET DATE OF REPORT I WELL M—MLLER (Sig ure) / I VOt t +A: 7. �..� -. CN,- MC �.._.., L April 1, 1977 Cl- Putnam County Dept. of Health County Building Carmel, NY 10512 Re: Well separation distance Gentlemen: The purpose of this letter is to put on permanent record the fact that the well on my property is located 88' from my own sanitary system. This is shown on Dwg. No. 2, S.0. 1655 by John H. Prentiss, P.E. submitted to your office showing sanitary system "as built ". The property can be identifiers as follows: Town of Putnam Valley Tax Map 64, Block 2, Lot No. 7.1, Wood Street, Town of Putnam Valley, County of Putnam,, New York. A copy of this letter, which has been notarized, has been filed in Miscellaneous Records in the County Office Building. Very truly yours, y , Robert Stapleton Wood Street : Mandpac',- NY 10541 is S Y Tar4n T v; vt, o i �nt ?r'; :ilr ,. ,,. ". ';`'r�. ;•�;�: . Ilia .l,i I { Ik i 0 Owner or Purchaser of Building Municipality lPc6er4- ST JA_ �te.✓ Building Constructed by Woop SrWe-e7' Location - Street Ti4o Std�ay C'OCoN0-44_ wao_D JFWI�fi� Building Type 77 of. !oV Section 02 Block 7 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- vices of . the- __Putnam_, County. ..Department .of .,Health. as to wnethe.r_-o.r.__'not ;tlie._ - failure of the -- syste?rr'to' operate was 'caused by the willful or .negligent act of the occupant of the building utilizing the system: Dated this day of PyTdily &-* 19r SignaturbA 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 BREWSTER LABORATORIES Sox 224 - BR61WSTER,' N. Y.' WATER ANALYSIS REPORT SAMPLE NO. 3829 SOURCE: Robert N. Stapleton — well supply Wooa Street tilahopac, New York coL,LEcrF.n: Feb. 19, 1977 BY: Robert N. Stapleton BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source 'of the sample was of satisfactory sanitary quality when the sample was collected. Feb. 23, 1977 R'�o# Bickwit P. E. Director u 1 BREWSTER LABORATORIES Sox 224 - BR61WSTER,' N. Y.' WATER ANALYSIS REPORT SAMPLE NO. 3829 SOURCE: Robert N. Stapleton — well supply Wooa Street tilahopac, New York coL,LEcrF.n: Feb. 19, 1977 BY: Robert N. Stapleton BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source 'of the sample was of satisfactory sanitary quality when the sample was collected. Feb. 23, 1977 R'�o# Bickwit P. E. Director u 4 .. :. _. ..:. .�,.::. r:.. _ ', ..; • �. -. .,. ..w...:b4b -. ,. .. , -, r7:. .. .. .. . .. s....... .+ . c,.., n- . sue, .. .. . ., . •.w�+�..ab .. ... , , .. . • er. I�fr q 18:trbert �t � �itF,ep�. et4n. 94F.D:io 4 Wood ,.rte and Shopis Ore Mahgpac.s N. Y. xQ341 Dear Mr. a7tapletoxii The County Board off' Hoolti reviewed, your apol catidn. fear approval to t6'9uttrdot a sewage disgoeal. $ystew on .your lot and has 4sked gae to reply to you on their behc xr* waiver from. stand 4rds relative to your pr000sed well and to the well on the F.Isasser proPerty was requested by Ut engineers John, ]Prentiss at the July ;04 tins Approval of the application Era: .Stafited by the 13oard on the can dition abet the*sewage,systeft conptrActiou is in conf©rmanee with the epSintering plans st be ttd3di. the► report as to soil, dated Axt -at 10 1976 and the following conditions $ �... _ That- the fill nec -Osso irlr in" - pl: d °-_. ..•._..po t f`roFie youz ri iraeer iricl.catixs acceptance of the quantity and quAlity -of fill is submitted to the D art�t prior to start of fouz►diatlon con- struction. 2 D That prior to. construction of the disjpos" trenches a report as to go&ll.:ty of f il. plAced, including percolation testa, be su ttd�€.� to the Board of Healthe Vory truly y€>,ura q Robert J. Caddells V.Z. Environmental. Itealth Director AJC/'ps Cc: Mr_. John Prentiss P-9. Putnam County Board of ii641th JOHN H. PRENTISS. P.E. CONSULTING ENGINEER ROUTE 6, BOX 353 (914) TRINITY 8.6170 10 August 1976 Putnam County Board of Health County Building Carmel, New York 10512 Att.: Robert Caddell, P.E., Director, Environmental Health Services Re:.Sanitary Disposal System Design for Karyn & Robert Stapleton, Wood Street T. Putnam Valley Dear Madam /Sirs, At your 27 July 1976 Board meeting you questioned the quality of the fill material and method of construction of the fill section shown on our drawing. Following is the construction method proposed: 1. On top of the existing soil place a nine -inch lift of suitable run -of -bank material to cover the entire fill section area shown on the plan. This material to be evenly graded and allowed to settle for a ten day period unless it.is.wetted or subjected to heavier than normal rainfall. 2. On top of the first lift place a nine -inch lift of clean fill, containing no rocks, organics, or stone1 arger.than one and one -half inch (1 1/2 ") stone -or g ravel This material is to be "Roto Till "ed or harrowed to the _ full eighteen inch depth and then level graded. This process will introduce capillarity between the lifts. 3. Place a six -inch lift of run -of -bank on the tilled areas including side and front embankments. Settle as 1. above. 4. Place a six -inch lift of clean fill and proceed as in 2. above. Tilling (harrowing to remain '18" depth). 5. Same as 3. above. 6. Same as 4. above. ... 7. Dress side and front slopes with run -of- bank /clean fill mixture. 8. Taper from the rear of the bed on a 5:1 slope to the wetland area with the run -of- bank /clean fill mixture. JOHN H. PRENTISS, P. E. PAGE: Two of two DATE: 10 August 1976 TO: Putnam County Board of Health SUBJECT: Stapleton S.D.S. Design Att.: R. Caddell, P.E., Director T. Putnam Valley 9. Install trenches, boxes and solid lines as per plan with trench bottoms no more than 18 inches from surface. 10. After final inspections, the trenches are to be backfilled and the entire area, side and front slopes and taper are to be covered with evenly graded top soil. This area i's then to be seeded.. Materials described are: Run -of -bank: Sand, gravel mixture as furnished by Red Wing. Clean fill : Non- clayey (silty) loamy soil. Using the above procedure, the system should be more than acceptable; and your approval is requested. VeT.Y.Aruly yours, iolin H. Prentiss, P.E. dHP /pr ... - -cc: Owner (2.)_. File I D R A F T Any design modification to overcome moderate limitations of soils is expensive,.service limitation of soils is extremely expensive, but it is necessary to accomplish adequate effluent filtration at the particular site. 11he- imported fill is to be applidd to an area in order to make up or improve the depth of percolating soil for a disposal system, that fill to be added may not be taken from the same pro- perty if it would leave the land stripped nor if it does not meet the standards setforth. Standards f0? fill Definition; Topsoil -.soil with high organic content Clay fine sand silt Loam texture The mix (if any) of fill must be uniform in composition and uniformly distributed or applied. USDA or Unified soil criteria T' f tie X4O_jj � ` r�J (24 `e All may be used. The fill may contain medium sand, coarse sand, very 4 coarse sandAor fine gravel with low plastici�y,,with less than 5% fines The. composite soil, after.60 days must have a conductance no less than 5 min. and no greater than 30 min. Topsoil may be used as cove but in addition to the built -up area. An impervious barrier, such as clay soils, �my be used to retain the perimeter of the field (all four sides). June 28, 1976 Putnam County Board of Health County Office Building Carmel, New York 10512 Dear Sir: I am presently attempting to build a one family dwelling for my family on Wood Street, in the `.Cown.of Putnam Valley. Due to the re- quired size of my septic system, I must place the system within seventy - five feet of my neighbor's well, instead of the one hundred feet required. The well mentioned above, serves a one-family dwelling, which is owned and occupied by ROBERT & MARION ELSASSER of Wood Street Mahopac, New York. I have enclosed a notarized statement from the ELSASSERS, which states that they do not object to the placing of my septic system within seventy -five feet of their well I have been told by ROBERT CADDELL, that I must receive your approval and obtain a variance to place my septic -system within this seventy-five feet, before he will approve the plan.for my septic system, His approval being necessary before I can obtain my building permit, from the Town of. Putnam Valley. I would appreciate your approval, as soon as possible, as I have already lost alot of valuable time in the starting of my construction. Robert No Stapleton Wood Street & Shopis Drive Mahopac, New York 10541 .(914) 526 -2945 w ':• NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL. CONSERVATION 340 -06 -0058 (FW -020 PERMIT t UNDER THE ENVIRONMENTAL CONSERVATION LAW ARTICLE,, 15,.! ?rotecti,an;of Water) ARTICLE 25, (Tidal Wetlands) 1 - ~ x ARTICLE 2.1, (Freshwater Wetlands) L___I ARTICLE 36, (Construction in Flood Hazard Areas) PERMIT ISSUED TO Robert N. Stapleton ADDRESS OF PERMITTEE .Wood Street and Shopis Drive, R.F.D. 4, Mahopac, New York 10541 LOCATION OF PROJECT (Section of stream, tidal wetland, dam, building) East of Wood Street and approximately one quarter mile south of Secor Road. _ DESCRIPTION OF PROJECT Place approximately 1000 cubic yards of clean fill within the adjacent areas of a fresh- water wetland for the purpose of installing one individual subsurface disposal system in accordance with the sanitary system design prepared by John H. Prentiss and dated June 7, 1976. COMMUNITY NAME (City, Town, Village) TOWN Putnam, Va I I ey COUNTY FIA COMMUNITY NO. DAM NO. PERMIT EXPIRATION DATE Putnam - -- - -- ]December 31, 1977 GENERAL CONDITIONS 1. The permittee shall file in the office of the appropriate Regional Permit Administrator, a notice of intention to commence work at least 48 iours in advance of the time of commencement and shall also notify him promptly in writing of the completion of the work. 2. The permitted work shall be subject to inspection by an authorized epresentative of the Department of Environmental Conservation who may rrder the work suspended if the public interest so requires. 3. As a condition of the issuance of this permit, the applicant has ac� 'epted expressly, by the execution of the application, the full legal respon- •ibility for all damages, direct or indirect, of whatever nature, and by whom - ver suffered, arising out of the project described herein and has agreed to ndemn•ify and save harmless the State from suits, actions, damages and osts of every name and description resulting from the said project. 4. `Any material dredged •in•'the• prosecution of the work herein permitted hall be removed evenly, without leaving large refuse piles, ridges across the ed of tire waterway or flood plain or deep holes that may have a tendency to ause injury to navigable channels or to the banks of the waterway. 5. Any material to be deposited or dumped under this permit, either in ie waterway or on shore above high -water mark, shall be deposited or dumped the locality shown on the drawing hereto attached, and, if so prescribed tereon, within or behind a good and substantial bulkhead or bulkheads, such s will prevent escape of the material into the waterway. 6. There shall be no unreasonable interference with navigation by the ork herein authorized. 7. That if future operations by the Slate of New York require an alteration the position of the structure or work herein authorized, or if, to the opinion the Department of Environmental Conservation it shall cause unreasonable tstruction to the free navigation of said waters or flood flows or endanger e health, safety or welfare of the people of the State, or loss or destruction the natural resources of the State, the owner may be ordered by the Depart - ?.nt to remove or ,ilter the structural work, obstructions, or hazards caused ereby without expense to the State; and if, upon the expiration or revocation this permit, the structure, fill, excavation, or other modification of the +tercoufse hereby authorized shall riot be completed, the owners shall, tlwut expense to the Stale, and to such extent and id such time and manner the Department of EnviromnenLal Conservation may require, remove all or y portion of the uncompleted structure or fill and restore to its former :ndition the navigable and flood capacity of the watercourse. No claim shall made against the Slate of New York on account of any such removal or leratjon. 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise provided for by law, such lights and signals as may be pre- scribed by the United States Coast Guard shall be installed and maintained by and at the expense of the owner. 10. All work carried out under this permit shall be performed in accor- dance with established engineering practice and in a workmanlike manner. 11. If granted under Articles 24 or 25, the Department reserves the right to reconsider this approval -.at• any time, and after due notice and° hearing to continue, rescind or'modify tfiis permit in such a manner as may be found to be just and equitable. If upon the expiration or revocation of this permit, the modification of the wetland_ hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former- condition. No claim shall be made against the State of New York on account of any such removal or alteration. 12. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others to perform the permitted work or as authorizing the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit. 13. The permittee is responsible for obtaining any other permits, ap- provals, lands, easements and rights -of -way which may be required for this project. 14. If granter) under Article 36, this permit is granted solely on the basis of the requirements of Article 36 of the Environmental Conservation Law and Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards — Building Permits) and in no way signifies that the project will be free from flooding. 15. By acceptance of this permit the permittee agrees that the permit is contingent upon strict compliance with the special conditions on the reverse side. 20 -4 (9/75) (SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT NO. 340 - 060058 (FW -020) UNDER THE ENVIRONMENTAL,CONSERVATI0N LAY ARIICLE 15, (Protection of Water) ARTICLE 25, (Tidal Wetlands) ARTICLE 24, (Freshwater Wetlands) g ARTICLE 36, (Construction in Flood Hazard Areas) PERst1T ISSUED TO Robert N. Stapleton ADDRESS OF PEkL IITTEE Wood Street and Sho is Drive, R.F.D. 4, Mahopac, New York 10541 LOCATION OF. PROJECT (Section of stream, tidal wetland, dam, building) East of Wood Street and approximately• one quarter mile south of Secor Road. DESCRIPTION OF PROJECT Place approximately 1000 cubic yards of clean fill within the adjacent areas of a fresh- water wetland for the purpose of installing one individual subsurface disposal system in accordance with the sanitary system design prepared by John H. Prentiss 'and dated June 7 1976. COMMUNITY NAME (City, Town, Village) TOWN Putnam Valley COUNTY FIA COMMUNITY NO DAM NO. PERMIT EXPIRATION DATE Putnam - -- - -- December 31, 1977 GENERAL CONDITIONS 1. The permittee shall file in the office of the appropriate Regional Permit Administrator, a notice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him promptly in writing of the completion of the work. 2. The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation who may order the work suspended if the public interest so requires. 3. As a condition of the issuance of thisi�ermit, the applicant has ac- cepted expressly, by the execution of the application, the full legal respor.- sibility for all damages, direct or indirect, of whatever nature, and by whom- ever suffered, arising out of the project described herein and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from the said. project.. 4.. Any material dredged in the prosecution of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of the waterway or flood plain or deep holes that may have a tendency to cause injury to navigable channels or to the banks of the waterway. S. Any material to be deposited or dumped under this permit, either in the waterway or on shore above high -water mark, shall be deposited or dumped at the locality shown on the drawing hereto attached, and, if so prescribed thereon, within or behind a good and substantial bulkhead or bulkheads, such as will prevent escape of the material into the waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. That if future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable )bstruction to the free navigation of said waters or flood flows or endanger :he health, safety or welfare of the people of the State, or loss or destruction A the natural resources of the State, the owner may be ordered by the Depart - nent to remove or alter the structural work, obstructions, or hazards caused hereby without expense to the State; and if, upon the expiration or revocation )f this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners shall, vithout expense to the State, and to such extent and in such time and manner is the Department of Environmental Conservation may require, remove all or ny portion of the uncompleted structure or fill and restore to its former ondition the navigable and flood capacity of the watercourse. No claim shall e made against the State of New York on account of any such removal or Iteration. 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or. for other purposes, and no claim or right to compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise provided for by law, such lights and signals as may be pre- scribed by the United States Coast Guard shall be installed and maintained by and at the expense of the owner. 10. All work carried out under this permit shall be performed in accor- dance with established engineering practice and in a workmanlike manner. - 11_- If. granted -under Articles ,24 -.or 25, the.Department reserves the right ' to -reconsider this approval at' any time and after due notice and hearing. to continue, rescind or modify this permit in such a manner as may be found to be just and equitable. If upon the expiration or revocation of this permit, the modification of the wetland hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 12. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others to perform the permitted work or as authorizing the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit. 13. The permittee is responsible for obtaining any other permits, ap- provals, lands, easements and rights -of -way which may be required for this project. 14. If granted under Article 36, this permit is granted solely on the basis of the requirements of Article 36 of the Environmental Conservation Law and Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards — Building Permits) and in no way signifies that the project will be free from flooding. 15. By acceptance of this permit the permittee agrees that the permit is contingent upon strict compliance with the special conditions on the reverse side. 5 -20 -4 (9/75) (SEE REVERSE SIDE) PUTNAM CO l,'TY DEPARTMEN 0 HEA TH ` i> U E` tiIECl �Th HEALTH S _T iyi TON. OF i _ Date � �� /g 76 Re: Property of . 41.1 Vey • Located at Lt/ao �. .s�. , k/g I_ rok- A r &I.- Block Lot 7.1 Gentlemen: . This letter is to authorize �' /�i�P�,�i'SS a 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 anti ro.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. Very truly yours, Signed Owner of ProLferty i e Moo f� I S e.-; AA4 e ac Ivy Address J��.E R.A ., # 29206 R.D. 6, Box 353 Telephone Address Carmel, NY 10512 914- 878 -61 Telephone Q�pFESS)UNr�� F v N, PR 'V vc,� I&A 1 292 ()' ��FrkE STNit�� a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA-SEEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /rca!nrn WAOJart, e /P„ Address `(/o o- . iJr �d Located at ( Street, _��o/ t. e-. 6 2. Block x- Lot 7,/ �Indl- Cate nearest cross street) Municipality. ��-q �/�y� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIPC� PERCOLATION PERCOLATION Run Eiapse Depth to Water W a t e we No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in`drop Inches Inches Inches Notes: 1) Tests to be. .,repea-eCz'at same depth until approximately equal soil rates are obtained at e . - ;, :::"aerbolation test hole. A].l data to be submitted for review. .2). Depth measurements. to be. made. from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTr'U).WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED E�RED IN TEST HOLES i DEPTJ-T:; HOLE_ G.L. 611 01' • i 1811 /� ®��►sa 2411 1 i.. is 3011 ii 3611 E' 42" f r 48 y i .60" 66" } fI 7211 ! 8411 �I INDICATE LEVEL AT THIGH GROUND WATER IS ENCOUNTERED INDICATE -- LPL_ TO !�AHU- C.E -WATEP LE�TEL _RISES AFTER BEIN ENCOUNTERED; - - 'TES`!S LADE T3Y��� �i�I,F�T,��7G. t. ��_�_ ���LeTa:r--oi 6��'f'�le DESIGN Soil Rate Used^ Min,/l "Drop:. S.D. Usable Area Provided F700 (i No. of Bedrooms -re, 0- Septic Tank Capacity Gals. Type o, -ceft/ 1i Absorption Area 'Provided L.F.x24" - ��`�b "— �"' width trench. t' p Other :Name John' H. Prentiss P ignat ' rEaSIONq� FN Ii Address R.D. 6, Box 353 O T ci Ca rme 1, NY 10512 THIS SPACE FOR USE BY HEALTH DEPARTM[ NT •0 Soil Rate Approved Sq. Ft /Cal. -c e '° Date FOP No. 292 04PTHE StAj�� It t3 U HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 1 �- CONSTRUi -I. ION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Val 1 ey Town or village . Located at Wood Street Section x G Block �- Subdivision Lot 7'- Job . ®• �� er Own Karyn &Robert Stapleton Address Woo St1 Shopis "br." j Building Type Framer Lot Area 1.534 A. Mahopac, NY 10541 Number of Bedrooms Four Total Habitable Space h 2400 Square F( Separate Sewerage System to consist of 1250 Gal. Septic Tank 500 lineal feet X .36 inch width tren To be constructed by i Address Water Supply: v Public Supply From X F Private Supply to be drilled by ? s' Address t Other Requirements Curtain Aratns• - 126t x 60" Average; R -o -B Fill Section - 6901` x 42" Deep I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal syste above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a Ions o e u na County Department of Health, and that on completion thereof a "Certificate. of Construction Compliance" satisfactory to the Commissioner of Healthw 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 v, place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the is! ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described abo will be located as shown on the approved plan and that said well will be instal in accordance with the ards, rules and regu as 1T1'ons of the Putna County Department of Health. 7 June 1976 -' X Date Signed P.E. R.A. _ Address Box .:35 License No. 29206 3. APPROVED FOR CONSTRUCTION: This approval expires one r from the date issued unless construction of the building has been undertaken and A revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of constructic requires a new permit. Approved for disposal of dome ry s wag d /or private water supply only. 11 az Date C BY ,y, Title '�l�i• ply " 0 Ul.e S2c c "ui� I' �vtts r,� ctg 21.1)76 PProval 1I �1 � iW to Gir.r5 Fill SpQeificcttii DEPARTIVIE Y10512 :.:... _ :... r� NT Of AM COUNTY Carmel, N. • V a1 l e 3 �� ; �� pUTN Health Services, putnam Division of Environmental pISpOSAL SYSTEM Town or Village 2 ' �4 Tax Ma 62 Black .O. 1655 "1 CONSTRUCTION COMPLIANCE FOR SEWAGE C RTIFICATE OF .1 Job S Maho ac Wood Street Wood St. & Sho is Dr. Sta 1 eton 36 inch width tre Located at & Robert Address i C Kar n Owner a Curtain Ora Owner 550 lineal Feet X 1t Dee Avera separate Sewerage system built by 1 at60 1250 MGaI. Septic eTa4211 Dee Fill Section; 8� Consisting of In Avera Tnc From Norman Anderson Ny Au 20, 7E Public SuPP1Y Putnam Valley, Water Supply' 1 Drilled BY Barger Four X private Supply Roa pate Permit Issued Address No, of Bedrooms ��— leted work (copieS of wh e Frame Yes artment of Building Type l the plans of the comp County Department Completed? as shown on by tnam Has Erosion Control Been essentially ermit issued _ remises were Con -led filed and the P P E X R.) s as listed serving the above premises ulations, P 29206 stem(s) the standards, rules and eg certify that the sy yyith and in accordance l 512 License No attached), 1977 Certified by B mel NY' of any III 28 Februar 9 6, Box 353` correction sewer R D be necessary to secure the c sanitary sew Date d void as soon as a Public such apPr Address Promptly take such act comae It an becomes available• necessary stem(s) shall p e system shall b rr . water supply lion or change is b the above sY orate sewerag void when a P tion, rnodi� s served by of the hall null and such revo occupying premise e. hall become er of Health, __-- Any person from such usag ter supply s of the Comms�lt�q resulting of the private `N n the judgment ! 1 ,ry� Title AM,— conditions the aPProval _tienoe when, I /1 / jOHN H. PRENTISS"I C -Itdt. ROUTE 6 BOX 353 CARMEL, N. Y. 10512 914 878-6170 County, I.Iep County Building Carmel, NY 10512 Att.: R. Tutoni TOP00 Stapleton Property Wood St., T. Putnam Valley DATE DATE 16 Seotember 1976 Dear Sir: We 7: have taken an average sample of the run-of- ba-fik-fill rriaterial,,an'dscreenid The material is of excellent gual ty, a highly - acceptable. - - ... Verytruly yours, -of JHP/pr cc-: St'apl'eton,- SIGNED BY iONS TO SENDER Form PK -8 @BusinqAs Envelops Mfrs.,Inc. a and pink .copies w.ltL carbon intact. Pink is-returned'With reply. _,_Peqrl� Ri -w York Melrose -Park,, 111. ver,.NP. Was the two undersigned, ROBERT & MARION ELSASSER, do hereby give ROBERT & KARYN STAPLETON of Wood Street & Shopis Drive•, Mahopac, New York permission to place their septic systemv for a now home they are going to construct, /\ within seventy-five feet of our well, Sworn to before me this Vie)'' day of June 1976 /S/ ROBERT E SASSER Tarp.n T. Cummings /S/ MAR ION-ELSASS Notary PLdiC. sia!a of NQw York { , f ... •.• •.....r nvm umrey oy surveyor norea below{y_ Well located by: Surveyors survey— _ — ❑_ — _ _ tc Well drillers report - s me sure men ls.12—_ i, Tank, boxes, p&, galleries 8 laterals located by:Contractor. a Engsneer. Healthd¢.pt: 6 Field Inspection by: Health dept ❑ do t e:� Engineer dater Y J ! X n N OT ES :I I`—l` � �- �?G •Gt. Lex'�rria /S .Z:., /1.M« .� p� '¢). tD,.� /i'1l Se f o ; L.. v ra.. r`ri r u 47' r a 1) 4,51 X � � ,.. c'� 4•rm • l rn / r�9 - -o,z ,le£ rat� s'r n 3. 3 O C is MIJ DtMENSIpNs N{ ui 1 I i i7_ r 43 A_ C :__?9__-B _•C 1 __ ii iJ . I I I I ITT F} I 1 A_ D - -''-- B_ D, 13 — r I = I 1 I� �r1 p 11 - — ^— ---B - -- �y. P It — ( ; Z >•7v .� r k.. A E c �� _ B E _ 1 1 oF55SWMd N A G =— 5 _ _ B -. G 10 j : :7j � I ! I . I _ j i � - ; t •k ,. H /N o rr�tr �.V =r��, 5� =.�r, !'� � �'-� J "A rl I _ t SANITA Y SYSTEM DESIGN S QUIL i I J OWNER: c, +s 0 •<L a` l° i Sr,a: ,-- _.._ --._.. :I LOCATION.Street:+�5 �` — e flown Y County I \' SUBDIVISION: Block, LOT N4._ 7, _ t r. ,' Surveyor: W Draw _ Date:I� t v_77 Scaler Z�,C Job N p. l6�T J JOHN H PR ENTISS PE CONSULTING ENGINEER rrnj nr errr,rm RD 6 Box 383 CARMEL NY 10512 — (9141878 -6170. r