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BOX 29
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4i i i '■ IL
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I• ',
■� yi LIU.
03643
. a . \'Alts -• •. —r - _• °-- _.�.- s- �^'^- •�.-- "°- ---r••
~} ,Division =of Ent!�ronmental Hea/ih Services Caimel N: Y `f0512 a. -11
.� .
` �• .:
CERTIFICATE OF CONSTRUCTION `COMPLIANCE FOR "SEWAGE DISPOSAL SYSTEM 11
_. _
Town or: V ag'e' °
r,
< ,, L _ R .
Located at Section �v Block
�` Lot' _ w Jo
(�„ I.�?LNper _11 ,..�. w _ ems- - .
Separate Sewerage System` built by Address
0 0 . 6 'r
}x} Consistmg,�of, / Gal�^Sept�c:Tank -� ,lineal Feet X - width 'trench .,
l.- _ - a Y`P _ g it t �yi x� �1`,.z ,+."3 �"'e L I i `
Other requirements = s
Water Supply _Public Supply From
€ a g t
( Pnyate �SupPly ;Dr�11edBy
'� 0, ddr�eie -
Building Type s.- No3 of drooms� Date Per }mil Issued
t f
Has Erosion Control Been Completed_, ca
• _ t� �� 'lalo",
:; a. G, . ses ere c'
I- ertif `that t. - stem s); as'listed =sery ng`'.the above premi w onstructed essential) shown on'the plans of the;complefed work ;(copies of which are
Y; Y
_attached); and,in accordance w�tfi,ahe standards ,'rules and' ^'regulations plan's_ filed a perm t iis' b - he Putnam'County. "Deepartment of Health
v s
/� } V/
Date CerLfied by P E R.A.
A.
n License No
Address 4 , 1. p y "
I. - Any,,person occupying premises served by `the above systems) shall: promptly take such action as may -be nec tsary to secure the_eo. lion of; any unsanitary
I resulting from_- -such :usage "Approval'.?bf the Separate.yseweragesystem shall become nulf.and void as soots as a publ�c'sanitarysewer' becomes'.
" "_ :
? available and, the approval of the- pnvafe,, ;avatar supply, s-'- all become null andvoid vJhen a public water supply becomes available Such ,approvals are,
su, "" ',.to modification yor change when, =in the judgment of the Commiiii of Health, such kcevoca w' modrfication or change ,is necessary k 1. __
y
€ r z CiZ's�' Title .�
Dete _ z '„t gBY s ?' ,.xe f i 2 w < e: , ' {'- ` c.
Y
f - : st
.. .. �.. -_... n 1�= _ ..J a v.... si4.� v. n:F� '!
/-,��, , � - ���77 . , _
- , ;y,Q' t -T .'-7— .+- . -" --• -a-7—._. - { - >�_-- �s 11 It, �. PUTNAM COUNTY DEPARTMENT �OF, HEALTH F
*�
,yks R ) p
. Diwsion " ' Environments/
Hea /th Services Carme% •N Y 10512
- .
rEONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM, k .1.111. ' 111111.1177111. . e 1 oeatetl. at 4� < 4 ., g tr � _ ' 11 �' ` / wn Vil I
f/ _.. To or la9e , 77 .11 /� w l
Si�bdivi$ ion M �� ? 6 Section
t Block
4 ,Owner % Lot J_ob _ I. R
,- 9 Ype`'`G��0 q } -1 Address , Q .0 I
,� Lot Area
Number, of Bedrooms �:
gSeparate"Sewerage System to consist of Y% Total'`Hatiitable Space - -
1 - �, Gai Septic Tank OQ ,• ,'Square Feet
k- I
'TO be :constructed by /C3 '' fjQ��� ��, • -
Ime- feet X
W
idth trench
- Water Address
SuPPIy Public SuPPIY -From t >.
I Prwate - SuPPIY to be drilled by , d .• ,�Q 66
/%) //�Q�
( Address a —_
F
, Other Requirements
L
i . :." - r, 1 11
.{ 1 - ij
t �}
;''- f represent that, am '
w
holly and.completely.iesponsible for the design and local
j
Y P4,
[ ,_hove described will be constructed =as shown on theta
ion of --Tthe Y
1. y 4 pproved'amendrrlent th'e'r`e „to ari' , Proposed_ system(s), . that, the se'parate'”
County Department of Health,• antl that on completion thereof a and accordance with the'standards ```
be sub,m_itted to 'fhe Department ,<and .a.=
t e of Construction Cornpliance - ,satisfactory ule
sewage disposal system
Ce►tif, cat s an regula ions o e _u nam
. _place .in good, operatin w written ;guarantee wUl be fuenlshed_ the owner his.,;uccessor 11. 9.condrtion.an
,rice of the a ,Y. Part of said sewage, disposal ;system tl
pproval of 'the urin "» , ',. s heirs or assigns by the bu /der,14hat �iof-
t will be Jocated asshbw Certificate of; Construction ;Compliance 9 the period of two (2) ;yea►
,. ,
n o__ _ approvetl` la'' of thep►iglnal`s ste s'imrnediately.followtn '- th
,. ,County "Department of Y Vr , or an re
P ,n and that said well will beiinstalletl' i
Health 4` , 'ti `, Y „Pairs thereto 2 #hat --- the `drilled well tlescrlbe habov�l
with he. standards rules and reg�'s o _ e
cordance j
1 Date < % f 'the Putnam .-
�.� la ions: o
J S�gneil'' � y Ir I Address " ��/�� %�� _ P.E. ��`R A
APPROVED FOR CONSTRUCTION: this. '�'''
regl , - -e'for cause or may Pp ►gyal expires one Yearfrom the date; issued unless construction •of the
requires •a eyy Y. be amended or modified when consitlered necessar ui di rig Ira Nbeer
permit Approved for disposal_of,- 'domes������� y by the0omisiay'channdk is . , 11 De 9e o "r alteration of ►construction
-
. By
- Title I
1:._�
.
P
AM' COUNTY "DEPARTMENT ,*7 0FktIffi.
HEALTH
D' J,,:-�
Wsion7 of
-a
CONSTRUCTION PERMIT
FOR -SEWAGE DISPOSAL -SYSTEM
0
Located
at
VL-/ ..Town or liege
Subdivisior, . c7m section
-'Bldck,
Owner Lot
Job
Building Type Address
Lot Are
Number Of Ij ed ro oMS
separate Sewerage System to
consist of Total Habitable Space
To be 'co'nstructed by Square .i
Gal- Septic Tank ackn� lineal feet X
Water Supply: Idth t
Address
Public Supply From
Private s
UP01Y to •be drilled by C)
Address,
Other
u
Re irern nts
q e
represent that
ab am wholly and completely responsible for the'desig
.c6ove described will. n And location of the . l,becoqstructeq:asshdwnonth'
unt y Department 'of Health, e. approved Amendment there to and, system(s); 1) t t
A
I7holly an co
Ith, and that on 6 nd, in accordance with the standards, rule a e. sewage disposal syjje
submitted to I that the separ
P stl0h.thereof a "Ceitificate
'Place the Department, and a writte-r of c9ristruction s An regu a
written will be Compliance" satisfactory '1� 'iOns 0
in. good operating condition any part of C t e
ance-6f the approval furnished the owner, his to the u n ' a
said - sewage dijp�jsil ..Successors, heirs or ass! mmissiorier of Hea
VAI Of the Certificate Of Constructi System cluiring'thd gns by-,th4:builder th Itliw
will be located as shown "on the 6p on Compliance Of the on period Of two (2) Years immediately f6ll At said IbUilcler )w
'roved Plan and tha 9 I.System or any
ty.-Pppartm I f t Saidwell' 11 r owing the date Of ihe:ijj
0 repairs thereto; 2)thii the drilled well described abo6i
Oalth. W.1 I be Installed 7ccordanc6 with the st
bat anda S. rules and-reg—U-10,3hso
e.
ZW 0 the Puinai
Signed
Addr
ass
P. E.
APPROVED FOR CONSTRUCTIbry'-. V
revocable f' - This approval expires one Year from the date' License No.
or,causeor may be amended 0 issued unless co _;K
squires a. new per it. ,amended . r modified when considered necessary by the nstruction Of the building has been Pproved
for disposal of domestic COmrhlssioner Of Health n undertaken a I nd,,. i ,
)ate saltary sewage, apd/�r P . r�ya!e w I .. Any change or alteration of co
B y / ter supply only, construction
e z
--------- Title
-9275-1-
1ABORATORYINC.-- ------
NORKIFOWNI-EDICAL
P.O. Box 99 321. Kear Street
Yorktown Heights, N.-Y..10598 245 °3203
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
1213=75
DATE RECEIVED —
OWNER
7
PATRICK DM _1
CITY, VILLAGE, TOWN 6 /OR NAME: OF SUPPLY DATE REPORTED
RD 18-75
SH CK DR. PU NAM VAIIEY. N.Y.
AMPLING POINT
PER ML. (Agar plate count at 350 C).1 COLIFORM.GROUP (Most probable No./100ml.) I HARDNESS I TOTAL - pprn
PPM NITRATES (as N) - ppm
IRON, TOTAL - ppm.
E (F) - mg./1-
9
These results indicate that the water was
YES Of a satisfactory sanitary qudi'ty when the
-
/ d
er
Own or Purc aser o t:�Bu"i-1 ding
Municipality
Section
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 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_.pf the_-natnam,.Cou ty,Departme�a :_g �I .elth.� '_to: whether.
��- failure of the system to operate was caused by the willful negligent
act of the occupant of the building utilizing the sys A .
Dated this Xc day of 19)2� Signat e >
Title -~
lz- 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
Bailed Measure from 1 d surface .
Lengh: feet or
umped'HI
S Stati j_taft Make
/ When Bailed Olout
_' T�Iasneceir: l! Inches Yield: flGPM r Pump e G'ft Length Ft4size`
. WA'
z co;4 L Z Q
7� :
co k
T�T
To:
From:
Subject:
PUTNAM COUNTY
DEPARTMENT OF HEALTH
MEMO NUM 9/l/78
FILE
Robert J. Tutoni
SCHUMACHER
SHAMROCK DRIVE
(T) PUTNAM VALLEY
It was reported to me by Ronald Stauffer, E.H.T. trainee
that he was refused.entry to the Schumacher residence for
the purpose of conducting a dye test.
I called .Mrs. Schumacher on the 16th of.August and ex-
plained the reason why the additional dye test was necessary.
She apologized for the previous refusal and told me they were
leaving for a vacation on the morning of the 17th and would
be available to this division to continue our investigation
e.a:r r,es.idence the firs -t wee' of
September.
RJT /ps
r'
i='UT'NAM COUNTY DE 3 RTNEN T OF HEA -r'
DI�'1 iJO,? OF ENL'IROPvrILNTAT, Hr.Pt�:T'H .S1'Ri.1IrEg
Date q7
Re: Property o
Located at
Seer.lon Bloc Lor
Gentlemen:
This letter is to authorize
a duly licensed professional engineer ✓� or registe._ed architect
(Indicate)
to apply..for a Construction Permit for a separate sewage system; tc
serve the above noted property in accordance with the standards, rules
or regulations as promulaolated by the Commissioner of the Ritnam County
Department of Health, and to sign all necessary papers on my behalf in
c.orinecrion with. this matter and ro supervise the construction of said
system or systems in conformity with the provisions of 7!rt.i,,]_e ILLS or
1.47, Education Law, the Public Health Law, and the Putnam Count37 San- -
Lary_ Co'de,.
Countersi cne 1,
�q
MM.,
Very truly yours, J
Signed
.ncr of Prcrc „ty
Address
Telephone -
Address ,UFfSS.O....
4AVIN 1W
Telephone._...__
a
PU NAM COUNTY DEPAPTMPF'.*C OF 1-f}.FtLTH
ENVTBC:iN11FNT -A!—., .J- [EALTH- SERtiLUS
Re: Property o
Located at
Section y
Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer a/ or regiseer 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 oil my behalf in
6
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 1L15 or
1.47, Education Law,.
the _Public Health Law,, and the . Putnam,. Count Saai -_
tary Code.
Very truly yours
Signed - ►Z� l _
qrcr of Property
Countersigned: xa
E/;, �
f ��� Address .
_ _ = Telephone
Address
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF EIr vti' OWSMkL" M� ILTR 'SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. D
Owner Address G.C�t11101,
Located at (Street c. Block Lot 3/
n ica e nearer cross street)
Municipality] Watershed _
SOIL PERCOLATION TEST KTA REQUIRED TO BE SUBMITT WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
No. Time
Depth to Water
From Ground Surface
Water ve
in Inches Soil
Rate
Start -Stop Min.
_Start
Stop
Drop in
Inches
Min. /in
drop
Inches
Inches
1
- 6,
,� �,
�5�
1215
2
4
5
2
3
5
Notes: 1) Te's�ts to be repeated at same depth until approximatelyy 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.
r
J
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
,.. _DESCRIPTION _ OF SOILS ETdCOUNT'ER.ED.. IN TEST HOLES.—.:—:
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
3011
36"
42'►
48"
5411 +�
60'1
66"
72"
78 it
-
84"
INDICATE LEVEL AT WHI CH . GROUND
WATER IS .ENCOUNTERED .,:30 �� :• - -..
TNDICArE'LEVEL`TQWHICH WATER "LEVEL 'RISES "AFTER °'
TESTS MADE BY }._ ./r7�
Date
r
DESIGN
Soil Rate Used�Min/l "Drop:
S. D. Usable Area Provided
No. of Bedrooms�-Septic
Tank Capacity /70 Gals. Type �,
sy�'—
Absorption Area rP ovided cro
L.F.x2�+" width trenc .
✓
her
Name
Signa ure ,..
Addre s
SEAL
i ' '�i A pE
THIS SPACE FOR USA, BY . �H DEPARTPM1 T ONLY: ,� ,p �.
�.
Soil Rate Approved Sq.
Ft /Gal. Checked by �''� «�„���►► ►`�� Date
I
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 Address /5r5�
Located W (Street Sec. Block Lot &1;2-
Indicate nearest cross s ree
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTICWITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run apse Depth to Water 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
4
2 /O.' /� - /v.. 2�
/��
/S% /
s� S
17A,
l�
IZL
49
61-S
2
3
4.
5
1
2
3
4
5
Notes: 1) Te'�ts to be repeated at same depth until approximatelyy 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 GILS-:ENCOUNTERED IN'TEST'HOLES=
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
611
12"
18ff
/17
2411
30"
30 It
4211
48tf
54.11
6011
6611
7211
7811
8411
IHHRTND...WATER, IS_ENCOLWE
RFD
-INDICATE-LEVEL'--AT.--t-. T
INDICATE LEVEL TQ_WHICH WATER LEVEL RISES AFTER BEING Eicoiiiii
TESTS MADE BY Date
DESIGN,
Soil Rate Used/��O Dftn/l "Drop: S. DI Usable Area Provided ._�00
No. of Bedrooms r Septic Tank Capacity /cZ_0 Gals Type
Absorption Area Provided ByZi L-F-x2411 36 \,I"- width trench. 6�
Address
THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY:
Soil Rate Approved Sq. Ft/Gal.
SEAL
Checked by
LLJ
Qj
PC
SS 10
e
7z:-t,
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�� •- I fjp,, �'�Ul MVIRONMENTAL HEALTH SERVICU - -
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