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03653
�� � � `��r � � �°� ''•; ;PUTNAM COUNTY DEPARTMENT: �OF HEALT•H � � � �A �.
%jDivisfon of Environmental Health Services Car N Y 10512_
-,CONSTRUCTION. PERMIT _FOR SEWAGE DISPOSAL SYSTEMQjgi�/�(�{,•(,
T vin or V e
I Located • at�" �- �% Section �r7 Slock -
v�siti:n Jilt? a. L @t—
y
_j�, �q�1���y=� r.
Owner- ".,S,KJ + KA LA
Building •Type
�� Lot Area. I I f�rC�S /fie - l
Number of Bedrooms Total Habitable Space r Square •Feet}-
°
�I•, �Z
>.SeparaW.Sewerage System, to consist of _= �L+1 u Gal Septic Tank � lineal °feet 'X � � width 'trench'.
To be constructed by 'H�`� r Address ;
Water Public Supply From-
Supply: e
-Private "Supoi`y to be drilled by
t
r v f
•Address -�
t
Other Regwrements m { s \
^d represent that I am whoily and completely r esponsibiefor ,t6edesignand1ocation 'the "Oro .'fystem(s);'1) ",that the : separate sewagefQisposa6'system._;. I'
above °described ,will be 'constructed as shown on,tbe approved amendment there to and in accordance with the'standards rules an 'cegu.a eons o e Putnam,
County Department , of -Health, and that on completan thereof a "Certificate of Construction Compliance '' satisfactory to, the Commssionero_f Heatthwilh
l be submitted to the Department, and a;;wrdten guarantee will be:furnislied the owner his successors,;heirsor assigns by the,builder.,Ghat said budder `will
place in good .operating, "condition any part of 'said sewage disposal'system during the period of two (2) years immediately :followinglthe6ie of. the. issu '.I
4 + ance of =the approval of;the Certificate of Construction Compliance of :,the original system or any repairs. thereto, 2) that he drilled well describe'd':above .!
will be. located as•shown on the approved plan and that said well w�li tie Installed m accordance - with; the standards rules antl .regulaons F of ;the PUtriarli
County 'Department of Health ..-
r O `�
Date Signed _ , P.E G� R.A. '
Address - License No;_� + '�
PROVED FOR CONSTRUCTION This approval expires one year from the date .issued unless construction of the building has 'been undertaken and is
focable for,;cause or may be amended ormodrf�ed when considered' es ry by {he Com sswner,'of Health ':Any change;,or alteratan of construction, .
wire's a ne permit' Appr fps- �rsposal of domestic san ry s age or pri w er, supply only
- e
PUTNAM COUNTY DEPARTMENT OF HEALTH
r +WS of �nWrmhmep it l Nealt/r SN�y�ces, �3!�np% n1. a' _ loft 1?_ -
�<
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
°- � Town oY VII
/,"� ,rte r (� (�
Located at: v Y`��•T" g'`' Section n Block v
Owner ( rfi7lJ /yf! Gfl r!y/� ►� ^,.T //' !� /f //� .,_ ".. �` Lot `%G4�/' _jo
Z N
Separate- Sewerage System built by \IVFA^� •`"��^'��1�'/� - ' -°"� v.�6�2'�v,. • •�?
�//�� �} Address
Consisting of ? =Gal `Septic :Tank o `� lineal Feet X width trench
33 Other requiremehts `
5�2 �AiL1 �d�rTi�llllG
f-
1 Water Supply, 'Public Supply From
4 Prwate SupP1Y, Drilled BY
-1:Address
f Bwldmg.,Type. /f f'[aw Y7/�+ No' of Bedrooms -'Date Permit Issued
LL _4f 7
`Has Erosion Control Been Completed
+ I certify that the system(s).�as- listed serving "the -above premises were constructed.esseritially as shown -,oh ttie plans of the completed work- (copies of which are
attached); and.in accor ance ith the standards, rules and - regulations' plans Bled and t ermit issue Putnam County Department of Health.
9 : ` Date.
Certified.b P E R
Address License No.
Any person occupying premises, served by. the above systems) shalt promptly take sui:Raction as- maybe 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 as a public sanitary -sewer becomes
available. and the - approval of -.the private water supply shall become null an : " hen- a, public ,water ; be."co availabie. Such -approvals are
1. j subject ` -to modification or change When;,, in'the `judgment of the missioner Health, such revo vin, modified or change is necessary.
t Date • G / BY "• tle` .
{
9105
YORKTOWN MEDICAL LABORATORY INC.
: V:0: Bbk 9 9 Strut
Yorktown Heights, N.Y. 10598 245=8203 '
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
NNER DATE RECEIVED
PATRI CI A GALBRAI TH
ITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED
2-39 ROCKLEDGE RD. C -1 MAHOPAC, N.Y.
AMPLING POINT
TAP
iACTERIA PER ML- (Agar plate count W'13350 C). COLIFORM. GROUP (Most probable No, 1100m1.) HARDNESS; TOTAL - ppm
8 LESS
)ETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm.
'LOURIDE (F) - mg. /1.
These results - indicate that the water was YES of a satisfactory sanitary quality when the sa p e w s c eoted.
r'
j
PER: LAKESIDE PHARM. i.
/x
A. H. P.ADOVAN , M. T. (ASCP)
Gentlemen:
It 'T 01' HrAuif
MITN"M M'NIT
'IMALT11 SFP\k'fCrS
Date \, �` 51 -1 q 715 ,
to
Re: Property of r, i?-, YD 64t, vsrz,,+) j'
UT
Located at
Section Block Lot 12,12
.This letter is to' authorize 1
i-duly licensed professional engineer or registered architect
engineer
to apply C)
for a Construction Permit for a separate sewage system; to
serve the above noted property in accordance with the standards,, rules
' lations as promiulagated by the Commissioner' of the Putnam County
or re.cru C3
-Department- of Health, and 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 'M
or
Law) the Public Health Law, and the Putnam COUnty Sani-
tary Code. .$Bsn C,
0
0
.4
(A
'a
04, 916
TS
-74
Pi aAA 1910 6.
Very truly yours
Signed-
. tamer of ProperTy
Countersigned: -c7s���
P.E.,I R.A.
Address
015:6
Telephoiie
Address
Telephone
a '
DELL COMPLETION REPORT PUTNAM COUNTY DEPP RTMIENT OF HEALTIi
1171 Division of Environmental licalth t- vrvicvs
COUNTY OFFICE EJUILDING - CAHMEL• NEW YORK
- e.,:: >; ,bltiie :iia;a 1s.,t c>aTpfetr. b;: v;.ILdC411ar:ind.s(F+- W— to; Goi"Viae crR=tiy �tfi�er °wref� Fr5tr5ivrgrte�,it�af.° -,�
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance Is' issued.
REPORT MUST RE SUi'MI1TED VATHIN 30 DAYS OF t:�LL COPPLETION
'TH FROM LAND SU±iACEI Skotch exact locai:dn Ol well Ni:h. Oi513nClS, to at toast
FORMATION DESCRIPTION two permanent landmarks.
If yield was tested at different depths dvrino drilling, list below
FEET GALLONS PER MINUTE
WLLL COMFLt''.3"0
r I T UATF OF FtLPORT I WFI I r11111 I Fn 151nnaturef 7i1 ;l
NA
ADDRESS
OWNER
LOCATION
OF WELL
Rto. 6 Stieot) (To n) (tot'Hunaer)
T
-6 -J'7
BUSINESS — - - -- -
-
0
PROPOSED
DOMESTIC ESTABLISHMENT FAR1A u TEST WELL
USE OF
VJEII
OTHER
SUPPLY INDUSTRIAL CONDITIONING )
DRILLING
COMPRESSED Q CABLE Q OTHER
EQUIPMENT
ROTARY ,'�( AIR PERCUSSION PERCUSSION (Specify)
CASING
- -DETAILS
LENGTH (test) I DIAMENR(inches)
WEIGHT PER FOOT Fn
' ❑
DRIVE SHOE
RYES ❑
V0AS CA5ING GLOU D?
�
77
)rJ THREADED WELDED
NO
YES D NO
YIELD
HO G.P M;
YIELD (G.P.M.)
TEST
CAILED PUMPED ® COMPRESSED AIR ^U -SRS
WATER
MEASURE FROM LAND SURFACE- STATIC(Specilytect)
DURING YIELD TEST( loot)
Depth of Compte!ad Well
LEVEL
in feet below Land svrface:�)
-- - - -_
MAKE_
LENGTH OPEN TO AQUIFER (leetj
SCREEN
-
DETAILS
SLOT SIZE
DIAMETER (Inches)
FIFGRAVEL
Diameter of well including
GRAVEL SIZE (inches) FROM float) ., TO (loot)
D:
gravel pack (inches):
I
'TH FROM LAND SU±iACEI Skotch exact locai:dn Ol well Ni:h. Oi513nClS, to at toast
FORMATION DESCRIPTION two permanent landmarks.
If yield was tested at different depths dvrino drilling, list below
FEET GALLONS PER MINUTE
WLLL COMFLt''.3"0
r I T UATF OF FtLPORT I WFI I r11111 I Fn 151nnaturef 7i1 ;l
5: .. -.ate= e - .�K- e. »•.ye a` >rr 4 - e ct- .,.. _ , .. . -..v" , «» . ._.
. •'i�i'i"'. �Yi "�'l�'�Yi�:IC[�'4ai`1 "� ' -1'� �, .°•- •:•:�
Owner or Purchaser of Building Municipality
owner B
Building Constructed by Section
22 Shamrock Drive
Glockamora.Acres
Location - Street Block
3 BR high ranch 22•;_
Building Type 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_- _
of�- pufneue LieFartm :t°
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system:7.7
Dated this 8 day of Dec. 19 75 Signature
T i t 1 e
il' corporation, give name
and address)
- - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION 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
4
'SANITAibe SYSTEM -- DESIGN .CRITERIA
S'e-Oti6;data transf6ired.- from, :Appr4v6d
�4 tliid�liii Z, 5
divistoft,plaur- a Y',
410 1
revised 'June 7
Percolation minutes
low 70
o rock' or ,.water be
12 . of. ii, A
6 ,
el requared
:Effluent be pumped.
s.
.2. Sy ster I a to'consist of 180 absdOtion -trenc :t
36" wide x 24" deep, spaced 90 -o;c.
3. Septic tank to be 900 galons- concrete.
'Siphon tank to bee 500 galons- concrete.
4. Fie Ids to be 4 perforated Orangeburg pipe
oreqquai; 4" solid tank to junction box and be--
-:4iahing of tile run; 4'p solid cast iron.'. pipe
I i4* hiAite- to septic tank and from'* septic
siphon tank.
S. 'S e tank shall be equiped with an electric.'' �4
automatic high leVel alarm system ta
a bell alarm within the proposed residence.,.
6. All construction. :County be performed. in , accordance.
with the bea ' 1 ' th codes of Putnam and7 146w.
York Stat&. see N.Y.S. bulliten'1,6 Tart- ia.i, P..I-I
4J_I �'.t r3ui-4
CAL IGI
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M4 CP
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