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03637
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PUTNAM COUNTY DEPARTMENT OF HEALTH Permit f �/ r
Division of Environments/ Health Services, Carmel, N. Y. 10512
CONSTRUCTION .PERMIT FOR SEWAGE DISPOSAL SYSTEM
Located at SliaifirocC Drive `
Subdivision- Sect. B, Glocamorra .Acreauna. Lot # 11
Owner/Address Re Tual, Mahopac, NY 10541
Building Type One F:am Res Lot Area 1 Acre
Number of Bedrooms 3 Design Flow G /P /D 600
Separate Sewerage System to consist of 1.000 Gal. Septic Tank
To be constructed by Owner
Water Supply: Public Supply From
Putnam Valley
Town or illage
Tax Map. 681I~ lock 5 rot - ] 1 •.r
Renewal _[]_Revision _ 0
Date Of Previous Approval
r
Fill Section only ❑
P.C. H. D. Notification Required
and 420 LF of 2 ft Wide Trenches
Address
XX Private Supply to be drilled by Norman Anderson
Address Barger Street Putnam Valley, NY 10579
Other Requirements Curtain Drain
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 system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e u nam ?'oi
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 ccessors, heirs or assigns by the builder, that said builder will
place in good operating contrition any part of said sewage disposal system during the per of two (2) year immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original syste r any repairs the feto; 2) that the drilled well described above
will be located as shown on the.approved plan and that said well will rl—n i�Iled in accordanc it the stands s, rules and regu ads. t the Putnam
County Department of Health. \. ,; �,
Date 10/4/84 signed
P. E. R.A.
Address Muscoot North R #2 M o ac NY 1054 License No. 11056
APPROVED FOR CONSTRUCTION: This approval expires one y r fro the date ued unless construction of the building has been undertaken and is
revocable for rouse or may be amended or modified when conside d ne scary by a Co trey of Health. Any change or oration of Construction
requires a new permitt..► Approved for disposal of domest ni sewage, a /or p vate or supply only.
Date .' d— By Title
Rev. 9 -81
PUTNAM COUNTY DEPARTMENT OF HEALTH
r Division of Envkoemeetal He" Servioer, Carmel, N.Y. 10512 .
. Blrgdregr Mast Pil'bvlde ,�(� • � I _ Qr
P.C.H.D..ParmftP........
3
CATE OF CONSTRucnw COMPLIANCE FOR SEWAGE DL4POSAL SYSTEM PUTNAM VALLEY
Town or �
Loaltedu SHAMROCK DRIVE Tax map 681I g 5 11
Owner /applicant Name RORRRT TUAL Formedy Sabdl deu Name GLOCAMORRa,ACRES
14 MaSngHAMA SHAMROCK DRIVE, PUTNAM VALLEY ztp 10579 Subdv. Lot # 11
Fee Enclosed Amount $10 0.0 0 Date Permit Issued 10/22/84
Separate Sewerage System balk by OWNER Address
Consisting of 1 , 250 Gallen SepdcTaskand 420 T,F OF T.F,ACHTN r� FTRT.DS
Water Supply: PublIc Supply From Address
M X Pdvate Supply DrlDed bgRORF..RT MTT.T. Address RREWSTER, N _ Y = .. 1 0 57 9
jgwIftgTypsONE FAM. RES Lot Size 1 ACRE Has Erosion Cnnrrr,l RPPn rrim lPt'Pti9 YPS
Number of Bedrooms 3 Has Garbage Grb wen Been Mete led! N
Other Requiremente CURTAIN DRAIN A
I certify that the system(s) as listed serving the above premises were a ted assent ly on the of the completed work ( copies
of which are attached), and in accordance with the standards, rules an regu tic 9, so a the f11 the
permit issued by the,
Putnam County Department Of Health.
Dab 3/5/90 Certified by V.E. P.A..XX
Address
No. 11056
Any person occupying premises saved by the above systems) shall PrOmpIly l9ke such action as may be necessary to secure thq correction of any unsanitary
conditions resulting from such usage. Approval of the separate saworallb.Wistem pull become null and void as soon as • t;: unitay most becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes avalillabliL Such approvals we
subject to modification or change when, in the judgment of the Commissioner of alth, such revocation. modification or change Is necessary.
3/f39 Date h� ! ��� By�'� �c��� -G", Title ���
Yorktown Medical Laboratory, Inc.
LAB 1 32.011480
321 Kear Street
- 3 �Co
Da t e Taken: Time
-. Yorktown Heights, N. Y. 10598 ...
.:....Da
(914) 245 -3203
Date Reported:
FEE. 1 6198a
Director: Albert H. Padovani M. T. (ASCP)
Collected By: p1/r'.
,
T_
Referred By:
!�
Sample Location: h0tz,11S7~S'
,C Siff+
��3.
Phone y I . 4
L 3.r /3 v, MAIN � J
Phone #28 ��QZ
Repeat Test?_ _
Sample Type:
(check one)
Potable
LABORATORY REPORT ON THE BACTERIOLOGICAL
QUALITY OF WATER
_ Non - potable
GENERAL BACTERIA
,/'Standard Plate Count (CFU /1.OmL) r�
(Agar Plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (M_FT_)_
Total Coliform (CFU /100mL)'
Fecal Coliform (CFU /100mL)
Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total. Coliform: MPN Index (per 100mL)
Fecal Coliform. MPN Index ( per 100mL )
OTHER ANALYSES
REMARKS (For Laboratory Use)_
_ STP INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
_ Na2S2O3
Incoming
�LE 4 °C
GT 4 °C
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
LE = Less Than or Equal to
GT = Greater Than.
N/A = Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT M TIME OF COLLECTION.
For Lab Use Only:-
H/C to
Albert H. Padovani, M.T. (ASCP), Director
'— COUNTY OFFICE BUILDING • CARMEL, NEW YOFts
Ibis report is to be completed by well driller and submittee to County Health Department together with laboratory report of
tnalyvz of water sample indicating water is of sati:faetory bacterial c05lity before Certifieaie of construction compliance is issued,
REPORT FAUST IIE SUBMITTED WITHIN 30 DAYS OF LVL-LL COMPLETIO
&tPIK FROM LAND SJTFACa I Sketch o:aet location Of wal W ?IM atstaners. to It 1&231
FEET to
FEET FORMATION DESCRI?TION 11 two permanent )enam3r23.
0 8 I Clay & boulders •
8• 400 Hard granite O
+ 0.
If yield wai te+trd of dihv,ent depths during drilling, G.1 below
FEET GALLONS rER MINUTE Pi
400 71,2-
s haw. rock i2 0 04
0.1 WILL (AlAirulLO D C rTr
6VL :L U ! T a �e)
8/30/84 `�Jij''o ,Pres. -MILL 'DRILLING, INC.
-
oiFJF:Ee
ROBERT TUAL
PO Box 453, Bolling
Rd., Shenorock, NY 10587
LOCATION
(No. t SlroetJ
(Torn)
(tot N�mo&rJ
OF WELL
Shamrocki'iRoad
Putnam Valley
IMPOSED
DOMESTIC
BUSINESS
LJ f iaeUSHMENT
® FARM
❑ TEST WELL
USE OF
WELL
D SUPPLY
❑ INDUSTPIAL
❑
a OpHER
CONDITIONING
)
DRILLING
j —j
ROTARY
❑ COY-PRESSED
x AIR PERCUSSION
a CABLE
❑ OTHER
iQUTPN.ENT
._!
PERCUSSION
CASING
LEt•.:.IH (feet)
2 3
DIAMLIIR(1nCne3)
6
WOWIT PER FOOT
19
D
(L;I:fyE SHOE( LS CA aNG Gt:UTED?
DYES U
DETAILS
THREADED : WELDED
l� J YES (_J M01 NO
YIELD
TEST
SAILED
((��jj "outs
PUMPED ®R
G.P.M.
YIELD (G.P.M.)
COMPRESSED
AIR 6
71-,
712
WA7E2
McASUR: F.OM LAND SURFACE— STATIC(Specfty lee:/
DURING 71ELD TEST iteetJ
Depth of Completed Well
LEVEL
• 50
400 .
In feet below Land turfa:e: 400
MAZE
L:NGTH OF EN TO ACUIFER ( :aetr
SCREEN
DETAILS
SLGT S:�6:
DIAMETER (Inches)
!f GRAVEL
D�ometer of well including
GRAVEL S :ZE (ncnes) FROM (feet) TO (feet)
PACKED:
grovel pock (in:Aet):
I
&tPIK FROM LAND SJTFACa I Sketch o:aet location Of wal W ?IM atstaners. to It 1&231
FEET to
FEET FORMATION DESCRI?TION 11 two permanent )enam3r23.
0 8 I Clay & boulders •
8• 400 Hard granite O
+ 0.
If yield wai te+trd of dihv,ent depths during drilling, G.1 below
FEET GALLONS rER MINUTE Pi
400 71,2-
s haw. rock i2 0 04
0.1 WILL (AlAirulLO D C rTr
6VL :L U ! T a �e)
8/30/84 `�Jij''o ,Pres. -MILL 'DRILLING, INC.
PU1'NAM COUNTY DEPARTME U OF HEALTH
' DIVIS 0ii-'OF1U4\Fi Z0�AL'BEALTH`SMVIC. S `
"T
MR. R. TUAL
Owner or Purchaser of Building
MR. R. TUAL
Building Constructed by
14 SHAMROCK DRIVE
Location - Street
PUTNAM VALLEY, N.Y. 10579
Municipality
ONE FAMILY RESIDENCE
Building Type
68II 5 11
Section Block Lot
SECT. B., GLOCAMORRA ACRES
Subdivision Name
11
Subdivision Lot #
GUARAN= OF SUBSURFACE SFAAGE DISPOSAL 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 guarantee to the. owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
o to for a iorl of „two years immediately following the date of approval of. the
"Certificate of Construction Compliance” for 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 occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of --
the Director of the Division of Environinental Health Services 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 FIRST day of MARCH 19 90 Signature
Title
�h (Owner) - Signature
N/A
Corporation Name (if Corp.)
SAME AS SHOWN
Address
rev. 9/85
mk
OWNER
N/A
Corporation Name (if Corp.)
P.O.BOX 453.
35 BOLLING ROAD
Address
SHENOROCK,N.Y. 10587
FUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Robert Tual -- Address Barrett Hill Road, Mahopac, NY 10541
Located at (Street Shpparqnk Driyq Sec._ 68II,Block 5 Lot -11
(Street Sec.
nearest cross street)'
Municipality. Town of Putnam Valley Watershed Hudson River
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
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
9:45-10:15 30
15
17.75
2.75
30/2.75=11
2 10:19-10:49 30
15
17.75
2.75,
30/2.75=11
3
15
17.75
2.75
30/2.75=11.
4
PTH#'2 9:50-10:26 30 .16 19. , 3 30/3=-10—
...... .. ..
2 '16'
Notes: 1) Tests to be repeated at same depth until approximatel� equal soil
rates are obtained at each percolation test hole. All data.to e submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILI ENCOUNTERED IN TEST HOLES
._ i•i ... _.. ,...e- ,_r... ... ,. ... _.. ..t .. ... i - ...ila ^ -ti•,. rf ... _- i:L -. -.. _• .. ...-. . a -.v... - .
DEPTH HO : LE N0. DTH #1 HOLE NO. DTH #2 HOLEiO.
G.L. Topsoil Topsoil
6" - Sand & Clay Sand & Clay
12"
118"
24' "
30"
36"
42"
48"
5411
60
66"
7211
78tf
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTEREDNone
INDICATE LEVEL TO ..WBICH_.WATER LEVEL RISES AFTER. BEING- ENCOUNTERED_Non.e
TESTS .MAtiE .BST __.....::.. - - ...., . .
Joe"T- Greenberg "` �' -" - " D�;te�-" �" "1U/3%84
DESIGN
Soil Rate Used 11- 15MirVl "Drop: S.D. Usable Area Provided 5,.000 SF
No. of Bedrooms 3 Septic Tank Capacity 1.000 Gals Type precast Conc.
Absorption Area Provided By 420 L.F.x24" XX p th trenc .
R
er
Curtain Drain as shown on map.
Name Joel L. Greenberg Signatu
Address Muscoot North, RFD #2
Mahopac, NY 10541 63
6 F
THIS SPACE FOR USE BY HEAITH- DEPARTMENT ONLY: 0 110,5 j0
Soil Rate Approved Sq. Ft /Gal. Checked by Date
l89�y '
22 ?0
52� AG'
X00
`0T
c
\- X7.0
2 Zr5,c Y we�� ti
i A HO SE 6
N 8•
4 w000e"
5 /�.'• ea � � N
12566AL. .. .
\ _ ` T4NVt
O ` VP' a0 14\� l9
\ M1y 0.
� ID
R x(50. oo ,
Q
fjLl I LT
A1N5 N17t�- nN
n00 h,b N -3
74a r,- -N10d
i�
4
f
I
AS 6UtLT Lo,:-A-t- ! oi�l�
Al
- 19'
3"
All - 90'
8"
B1
- 70'
4 ".
Bll - 98'
A2
-.561
Al2 - 109'
B2
- 70'
`3 ".'.
B12 - 114'
A3
- 62''1"
A13 - 107'
6"
B3"
- 72'
S"
B13-- 109'
A4
- 68'
3"
A14 - 60'
6"
B4
751
B14 - 41''
A5 .
- 731
1011
A15 = 69'..2"
B5
- 78'
2!'.
H15' - 47'.-
A6
= 79'
8"
A16— 70'
S"
B6 `
-` 81'
8"
B16;.- 62'
A7
- 851 '
9"
Al7:'
47
- . 85':
6"
B17 - 54'
`
AS
-'91' '6
"'
A18:.= 95' .6!!::.
:B8
-'89!'
B18 - 65'
4"
A9
- .84 ! .
-Al 9, 7, 100,'
,.8"
B9'
-. 98'
B19 - 71':
4" .
A10
- 90'.
_10!'
4!'.
A20; - 109t..81
B1Q.- '102':
B20- - 79'
7"
THIS'IS TO CERTIFY THAT THE SEWAGE DISPOSAL.
SYSTEM WAS CONSTRUCTED AS INDICATED ON,THIS
PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME
BEFORE IT.WAS COVERED OVER. THE SYSTEM WAS
CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD
RULES.AND REGULATIONS OF THE PUTNAM COUNTY
DEPARTMENT OF HEALTH AND THE NEW YORK 'STATE
DEPARTMENT OF HEALTH.
ruLnam l:OUnV Department ai aeal" .
Jivieion of Endir ental Health Servioee-
opproved as noted for oonformanoe with
applicable Holes and Hegulationg of the
Patnam Couaty Health Department..
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