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03710
Jul 05 2011 12:19PM HP LRSERJET FR
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PUTNAM COUNTY HE A TH DEPARTMENT"
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
THIS- IS NOT A REPAIR PERMIT
PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE
All information below must be fully completed prior to any scheduling
SITE LOCATION 111'46 946L S7*" TOWN .O % J KA -12W
OWNER'S. NAME
MAILING ADDRESS
PROPOSED CONTRACTORANSTALLER
I
,7f,1-7- 11Y
PHONE # 3 ?17 -3oo- 7Z '3Q
AI-H ,P,4 & L A 1. S &CGt MAI -- i.s'- 0'40545 - 3 . OT-Ws /9
"C716 YMj2,y PHONE # f 45i -
ADDRESS `91 r 7 0o0f
t' !fit /T REGISTRATION,LICENSE #_,�
by
Reason for exploration:
❑ failure to surface O back -up In house Z find limits of system for repair ❑ other (explain below)
FOR COUNTY USE ONLY
3 �Z
ector's Sianature & Title Date
Appointment Date: Time: /0 e :�
kly: excel:septic
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR � / �-V
Internal Use Only PERAAIF it /C " 1.2- G — /
❑ Repair Permit issued in last 5 years El Wt in Watershed
❑ ' / Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑' Joint Review
SITE LOCATION /� � RVGQ .5% _ TOWNPI / lid °Ld- /3!! TM # 06 , 3 : %Zri /q
OWNER'S NAME A� PHONE # U 7m 14, 71- 3, "
MAILING ADDRESS ruggz5f rvw-4m L ;.
APPLICANT 0jr 6 l ?,4 Y I- PA I PG6� C9 wf jt g;� t2
Name & Relationship (i.e., owner, tenant, contractor)
DATE 71 FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER 00 15k PHONE #0 63
ADDRESS REGISTRATION /LICENSE #
Proposal pnclude a separate sketch locating the house, property fines, all adjacent wells within 200
feet of repair and the location of euisting and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair. .
I, as owner,agrg'e toffle conditions stated on this form
SIGNATURE/ y-'y TITLE Q. ,,4 N 6,12- DATE t L
(owner) V -�-
I, the septic installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE _ -� TITLE 6 WA16Q_ , DATE %
(inst�il�j
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfiilled until authorization to do so has been obtained from the Department.
INTERS USE ONLY
Proposal Approved 0 Proposal Denied ❑
Inspector's Signature & Title Dat6 1 Ex ration gatii
Re it eroposal is in compliance with applicable codes Yes lT No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2107
+�i�tx .•..: 4tx�'/. NBtai)[ �: uil t�Mi4C' �Y`, t1nWm4 .4Y' "Hrut},y�.wiu17'SR6' +�LV "='kY ?Vwe+4�'u�oW. , .•�•:- .'xa�aiieGkv...S.:GUY �::.hwvl Mgt;. isiskatW ':eGUea�[iv'.n�.tvsxdw:+5. ... tai:' r1t11ia3trSNiu:FdiliiiiKxtiidLf4. �i�a'Y��t:�:,.`�" "+w ;uivi+'sk:a.'::i+:uYitiwi+eG
. TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DE�T� HOLE HOLE # HOLE # HCL=
G. L.
�i
0.�
1.5, -eS'A
2.0' �5-em i o if
2.S
3.5' �foa
4. J' Jq.ndQ '
r -
6.0' S dl e1
6.6 MIX w
7.0'
7.5
8.0'
Indicate !eve! at which c-oundwater, is encountered
Indicate level at which mottlin, is oose-I -ed .
Indicate leve! to which water level rises after being encountered
Deep hole observations made by: Date
Desim Professional Name:
Address:
Sianature:
Design Professional = Seal
HOLE #
L
foli
IN
Ik
J>, i r
p t4 i 'I r, "r oilors1.1ii-x
/ (b ) st J?
LC41 'Cl.
LLO
>1 N V.
311
3snOH WOO,
It
IS
dOM --c WOVE 09,,] -?;SAKI -9 1 UIA Q
pliq
PUTNAM COUNTY DEPARTMTsI T OF HEALTH .
DIVISION. OF FNVIROI\iMT-,T1TATL HEALTTi SERVICES
` �COUYIT OFFICE, tUILDING, CARMP!,1,, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE, NO.
Owner_ Susan B. Graumann Address wee Arrows c/o J Gorman Putnam Va112.N•Y.
Located At (Street) Barger Street Sec. 68 Block 3 'Lot 20 & 1/2 of 19.
n Ica e neared cross street)
Municipality Putnam Valley(T) Watershed Peekskill
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Notes: 1) Tests to be repeated at same depth'u.ntil approximately equal soil
rates are obtained at each percolation test hole.- All data to be submitted .
for review.
2) Depth moasurements to be made from top of hole. .`'
Hole
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
No.
Start -Stop
Elapse
Time
Min.
Depth. to V.Tater
From Ground
Start
Inches
Surface
Stop
Inches
Water Levei
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
(1) 1 12:15
12 :36 21
22.5
25.5
3.0 .
7.00
2 12 :42
1 :05 23
19.75
22.75
3.0
7.67
Notes: 1) Tests to be repeated at same depth'u.ntil approximately equal soil
rates are obtained at each percolation test hole.- All data to be submitted .
for review.
2) Depth moasurements to be made from top of hole. .`'
i
TEST PIT DATA E E'QUIR'%D TO BE SUf3MITTE,D WIT11 APPLICATION
DESCRIP7'TOId 01" SOMS) IN TEST, IiOT-JES'
DEPTH HOLE. N0. 1 HOLE NO. 2 IiLE N0. 3
G. L. Topsoil __. Topsoil Topsoil
611
, I
11 Topsoil Topsoil Topsoil
12 _.
,
' 18" sandy, gravelly loam sand Y, gravielly loam sandy g ravell loam
'
!
2l `tt . I
:
3011. -
'36"
i
4 211
'4811
•
7211
2811
8+11
INDICATE LEVEL AT 1rIIiICH GROUND WATER IS ENCOUNTERED. None
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED,
TESTS MQDE BY John S® Romeo Date November 5.. T977
DESIM
Soil Rate Used g °IO Mirvl "Drop: S. D. Usable Area Provided ' 5000 SF +I.
No. 'of Bedrooms # Septic Tank Capacity 1200 Gals . j Type Iosnry
Absorption � Provided By 444 L.F.x2411 x ° °
Area P —�"— i�t�h renc
/M
of her
3`bedroom designed as 4 ASS ,o
Name John. a Romeo gna ure .'
Address 1 Northridge. Road S ® M
' U
Peekskill New York 10566
SPACE ONLY: ®o ®9fE0F AM ®°
THIS FOR USE BY BEALTH DEPARTbIR11T NEB
Soil `Rate Approved Sq. Ft /Cal. Checked by Date .,
}
i
rl
PUTNAM COUNTY DEPART sI T OF HT,ALTH
DIVISION. OF FNW.P3ONTAT,>`1TAL HEALTH SERVICES
" COUN'17 'OFFICE" BUILDING;'`. CARM'!I,,. N.. -Y. 10512
DESIGN
DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner
Deborah R. Lopez Address Three Arrows c/o Jack Gorman Putnam Valley
Located at (Street) Barger Street Sec. 68 Block 3 Lot 18 & 1/2 of. 19
n i.ea -e nearest cross street)
Putnam Valle T) Peekskill
Municipality, y ( Watershed '
SOIL PERCOLATION TEST DATA REQUIRED TO BE SIM14ITTED WITH APPLICATIONS .
e:
Hole
Number
CLOCK TIME PERCOLATION PERCOLATION
Run
Elapse DeptF to %a er water Eevel
No.
Time From Ground Surface in Inches. Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
(1) 1
.12:29 12:54, 25 18.75 20.75 3.00 8,33
2
1:00 1 :27 27 19..00 22,00 3.00' 9000
3
101 .1:58 27 19.50 22.50 3.00 9.00 �(
(2)1,-
12:38. 1:02 24 17.75 20.75. 3.00 S :00
1 -36 _ 25,..........
3
4
3
- ,
5
Notes:
1) Tests to be repeated at same depth until a.Proxima.tely equal soil
rates
are obtained at each percolation test hole. data to be submitted
for
review.
2) Depth moasurements to be made from top of hole.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. _3186
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide
04 P.C.H.D.PermitN— --
T
_CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley
- —.. .._
� To�rm or. village .'
Located at Barger Street Tax Map o8 "&-3-- Let 18 -12 -20
Joseph & Klara Ml w i Lo ez & Graum� — L�p l &2
Owner /applicant Name RD 3pP12 Putnam a eyb tSea Lo 7 °O��sion NameCrrc`117maY1 Sabdv. Lot N
Mailing Address P Y. Date Permit issued }
Separate Sewerage System built by 50 Louis Malluzz0 3d,,�a Somerset Lane Putnam Valley, N:
o renc
Consisting of Gallon Septic Tank and
Water Supply: Public Supply From Address
X Anderson Well Address Barger S ree nam ey,
ore Private Supply Drilled by
N. Y.
Building Type Contemporary Has Erosion Control Been Completed? Yes
No
3
Number of Bedrooms Has Garbage Grinder Been Installed? °
ROB Fill Placed in Septic Area for gravit�������,F
e
,
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as goo
F
thgi•pl Q•ompleted work ( copies
of which are attached), and in,accordance with the standards, rules and regulations, in accordance w fs(2$4 plafi�yi ah� the permit �ised by the
Of Health.
Putnam County Department
November 2, 1986 �`
�'" r� �`' �` y :.E. R.A.
Date Certified by —
ILI nee No.
Address
Any person occupying premises served by the above system(S) shall promptly take such action as may be°®ece toJWWGA o correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null andflvo? b(- sanitary sewer becomes
the approval of the, private water supply shall become null and void when a public water .lo p iVbh. Such approvals are
available and
subject to modification or change when, in the Judgment of the Commissioner of Health, ch revocation., m
fl u oo�ad► change is necessary.
/ /
Title �_
Date -� G J Ca g.
--
J. S. ROMEO. PE. LS
CONSULTING ENGINEERS do LAND SURVEYORS
1 NORTHRIDGE ROAD
PEEKSKILL, NEW YORK 10566
914737 -1056
November 5, 1986
Mr. John Karell Jr. P.E.
Director of Environmental Health Facilities
Putnam County Department of Health
County Office Building
Carmel, N.Y. 10541
RE: Final SSDS for Joseph & Klara
Mlawski - Barger Street
Town of Putnam' Valley, N.Y.
Dear Sir:
You previously.requested any information pertaining to the.above
SSDS final locations.
i
This property originally was designed as two separate properties
for Grauman & Lopez in November 1977, with the latest revision
on Jan 31, 1978.
Work began on the parcel known as lot No. 1 of Map 1627 soon after
the time of last revision. The home was being constructed by
Louis Malluzzo, a local Putnam Valley contractor.
Construction continued at a very slow pace, and the Graumann °s
finally sold the property to their cousins the Mlawski, who were
-- - -- _ - abroad :and-= planned to -= move baeka to- tae= �Ur�aed= .States.. 'There r �v<
did not seem to be any particular rush about construction and I
spoke to Mr. Malluzzo many times and he said he worked on the house
whenever he had free time from other work. j
In 1981,.the separate sewage system was installed in front as per
plans, and I measured it for the records. However, the well was
not installed and I never was given any guarantees, or other
necessary documants for the property.
i
This remained dormant until recently, after receiving your letter,
I spoke to Mr. Gorman, the original owner of the property, and
also a cousin of the Mlawski° s. He said th(y were in the states
and now wanted to the sell the house, which was almost completed
but never lived in.
The Mlawski °s finally came to my office and I explained what was
reuuired. I now have the well.log from Mr. Anderson, the water
test from the Yorktown'Lab, the guarantees signed by the Mlawski ®s,
and the $25 check for the Putnam County Heqlth Department.
Mr. Malluzzo, the contractor, passed away earlier this year,
and thus could not sign the guarantees.
I ho e the above clears up this matter, and a final SSDS
P
completion compliance will be approved.
Very truly yours,
JSRs clr John S. Romeo .E.
edical Laboratory, Ins. C LAB
r I 9 5 I
(orktow M ry, IL i
321 Kear Street
,Yorktown Heights, N. Y. 10598 Collection Station Used:
Carmel Peekskill V
..(914) 245 -3203. _ — —
..,� - ...R -,_, ,�__.; itv.:
Director: Albe►t H. Pac Wml M. T. (&0)
1 Date Taken: /O 12 -gf s
& Date Received : /D z?% KL ,DDG."..,
Date Reported: .2
Collected . By: !
Referred By:.
L J J Sample Source:
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
!� Standard Plate. Count per 1.0 ml
(Agar plate @ 35 0C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform ner 100 ml
Fecal Coliform ner 100 ml
— Fecal Streptococcus per--:100 ml
MOST PROBABLE NUMBER.TECHN.IQUE (MPN)
_.� Total Goliform: ..MPN.Index per-10,0--ml....
Fecai- C- oliform: MPN Index per 100 ml
OTHER ANALYSES
THESE RESULTS INDxICATE THAT.THE WATER SAMPLE. (WAS (WAS NOT) (NOT-APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING 0 T NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, A TIME OF COLLECTION.
<
Albert H. Padovani, M.T. (ASCP), Director
LEGEND
RDS - Recommend Disinfect -
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
WELL CQ. P TION AEP"QAT PUTNAM COUNTY .DEPARTMENT OF HEALTH
3171 Division of 6vironrv41%'uI Health Services
COUNTY OFFICE BUILDING • CARMEL, NEW YORK
Thro report ifl to 6e completed by welly Iier andjsubmitted to County Health Department together with laboratory report of
=aalysis of Mlatsr sarn�lle•rnd�catng water is of satisfactory bacterial puality.before certificate of-oonstruction compliance is issued. .
REPORT, MUST Bt SUBMITTED WITHIN 30 DAYS OF , WELL COMPLETION.]
CWNER•'
LOCATION
(No; a Strut) (Lot NYn,e1�)
t) loan)�j
BUSINESS
'_ C)
M0►0fED : `''
QOAkE571C ESTABLISHMENT FARM TEST WILL
USE OF
'
weu
PUBLIC AIR .: OTHER
(�
C� CNDITIONING
;UPPLT l_J IND�51RIAl
— ORIllINO
COMPRESSED CABLE OTHER '
CI PERCUSSION a
�EQtJ1 MENf
, ft ANY AIR' PERCUSSION (Specify)
INIi r
LINO ! (MI
DIAMET7RACO OS1
��
WEIGMT� /OOT
( .
D
NO
YES
NO
DET l!i
4.
"
.L.j THREADED WELDED
rES
YIi�D
t HOURS G ►.M.
�
YIELD (O.P.RI )
TfEff,
jLEO,• .. . :. PUMPED COMPRESAD.AIIC
WAY
p1Elt8 RI PROM LAND SUR ►ACE STATIC(Soeclty hot)
. DURItdO YIELD TEST. (1001) `
DePM, of Con olehd Wdl =
IEVEI
''.
In fsht k »bw Land sYefaoae
l NOTN Or TO AtlUl ER (I0sU
SCIII
DE /Allf
L I DIAMETER (Inches) = s (Not) O IeeU
Diame 1w of well including , t l
PACKED, srovil peek (Inches)
ot►Tw ili0(c .u11ib
iYRFA
\
SA4tch 'axoct IowfMn e1 WWI r11A tlleleNG" Is et Kist
PORMATION'DESCRIPTION
two atnrRmnt (thdinarRa.
;r
J �
/�;:
M
If Ot d,fFrannl drpY116• dYrltlg dlilhng, 11 IJ�IOW
GALLONS PER MINUTE
a, J.
i
-
G R
RI R (Sign, ' rs
WELLT
."
o .Z
�t
• Y
Owner or Purchaser of Building
.Building Constructed by
JOSeph Vic, Ua % tllawski
Location - Street
,,9q
Municipality
fttrger ;street
Building Type
utnm Valley
Section
Block .e..-
f
66 18+19a -20
Lot
Subdivision Name
Subdv. Lot ##
1 � 2
Co°lt® C3&MANTEE 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 guarantee to the owner, his success-
ors, 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 determin-
-
at on of the Director ":�f thP.Divisin;:ofErivironmenta3 Hea=lth- Services - - --
of the Putnam County Department of Health as to whether or not the fail- L
ure 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 19 Signature
Title
Oct lj 86 Corporation Name if corp.)
Address-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WI,TH 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
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CONSTRUCTION PERMIT FOR S@
Barger St7
Subdivision +'Z4p8Z 8C GTBLffif
�{ Deborah R:
owner
v Ranch
Bu�l'dmg TYpe ,
I Number of Bedrooms, Deslgn.°
Separate Sewerage System to consist of.`
trn :She]
T.o be constructed by
Water Supply Public Supply I
v ,
` X Piivate SuPPIy
f 'Address•
i Other Requirements ROB.
represent,;that I ant wholly,ancl complete)
above descrobed will be constructed a's shots
r >County Department -of Health, arid that:
k be submitted to'the Depart - me sand 'a If - - �_.. _
y w L� „B,v�,�� E,T i' h�I 1
777, 7
TNAM COUNTY DEPARTMENT OFD HEALTH-' °_�
n of Enviro i ental 7146 altti Services Carmel
GE, DISPOSAL SYSTEM =. Putnam Valley (T)
44 • s - - Town or Village
68 L?iock
4 = Lot �7 Il eh
pe Ja.ek Gorman
Address i
4Lot Area 2 1/2 Acres n Three Arrows, Putnam all N.Y.
a
te+'' by L YLx xFp -s fl h' "✓'.+t }? CM�Q 'f•yirR t 4
N � > �Total'Habitabte Space' � Square Feet
� Gal Septic Tank and -: _ . 5
n _GaBd.ner�1 � `' �a iiddress Stevenson Avenue - .'�
Pee�skill�
&-Y 10566 j
e drilled by ATlderSOn Tiiel� Drill @r5. 1
Barger Street PutnamwValley, N.Y. '
placedyin^front of house _:for raising Oracle of septies .
sponsi'le for the designand locaf�on of the proposed syst is I ii_ by separate sewage disposal system i
theapproved amendment thereto and in accordance w`i -t a 1�`� rend _r.egu a ions o 't e Putnam
"Al. mpleUon thereof a- "Gert�fiwte',,of ConstiucLOn "Comp) _ _ tiy3:Comm�ssioner of Health will
tenFguarantee; will be, furnished the owner his 3uccetsSor C s lon builder ,that said 6u' ` ilde'r wilt
of said sewage disposaj system,,durmg the period dr >, y _e�� 81 i of the issu
onstrucUOn Compl�ahce of the': or�ginalysystemtor an y° irs, Yhae4rilled well described above
ndAthat sai'd well will be installed in accordance wits fie` stan an'j la ions" of the Putnam
�- I
i November. 17 1(Y17
7r_. -" Signed 'y °p • P -or R.A.
®<
Z Northrd e R Peekskill N Y' 846
Address - L�nse No
3
���[C8W46 X27 (j
APPROVED FOR= CONSTRUCTION Thisapproval''expues one year from the' date issued unless cons% n11�s1t ��ng =has been untlertaken and is
revocable "for cause or,may.beamended or modified when considered "necessary by 2he'Co is one- of Hie el c ange or alteration of construction
1 requues a ngew permit Approved for disposal of domestic nits wage . and r i at up�ly only ° i
8Y
5
i
A fred 'ller
///...w`.:... .ca -• ...., a ._ _, , . _. .... .. i.� ..- r •; • . - a: -- >�. 'o.y - .... ..a ...
./Z, 9i773� oclie,P, —4
January 26, 1978
F
Putnam County Dept. of Health,
Carmel, N. Y.
Gentlemens
As owner of the property adjacent to and north of the
property owned by Susan B Grauman, please accept this
as an authorization to Susan B Grauman to place fill
on my property in connection with the construction of
a driveway as shown on the plan for septic system as
designed by Romeo - Romanelli- Amico, PC, 1 Northridge
Road, Peekskill, New York.
PUTNAM COUNTY DEPARTNIN T OF HEALTH
-.. DIVISION- OF ENV IRONMENTAL : -..HEALTH.-:-RICS
�. .s +n r2--, _. R.A. _....w .Y.. -.�:• ..f ._. _ SE
Gentlemen:
Date November ' 3 , 1977
Re: Property of Deborah R. Lopez
Located at Barger Street
Section 68 Block 3 Lot 18 & 1/2 of 19
This letter is to authorize John S. Romeo
a duly licensed professional engineer x or registered architect
(Indicate) -
to apply fo.r 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
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
sys_eirnr.or sysei `r�s.= :in.- :.cccz2foxxri_t_ t. _:. - r: _.... ., - -.
y_w�th:ti.h�- p- rouisiar�e -o� .4�tic�e "145 or-
---
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned: //�iL ---✓
Very truly yours,
Signed x
er of Property
Baager Street Putnam Valley NY
Address
P . E • 9 - .9 # . 027646 LA 6 - 8162
'• Telephone
1 Northridge Road o Al ENS
( Se a1c`Ot1 Nff
Address e aQ S Ro��Fa���� °
Peekskill, New York 10566
737 -.1056 _
Telephone :e s 27846 0
DAVID D. BRUEN
County Executive
JOHN SIMMONS, M.D.
Deputy Commissioner
VL CL LA L110111 ULJ VV11J U1 -LAV V1 V11 V V L11 JJ l 1 Q L 1 l.. ty
Barger Street (T).Putnam Valley
Dear Mr. & Mrs. Mlawski• TM 68 -3 -20 Lopez & G'rauman Lot 1
Recently an inspection of the sewage disposal system and well serving the above
captioned residence was conducted by a representative of this ,Department .
.Subsequent review of Departmental files indicates that a Certificate of
Construction Compliance has not been issued for the completed sewage system,
therefore, final approval of the construction of these facilities was not
granted.. While we realize the difficulty involved in locating older records,-at
this time it is requested that -you attempt to locate the following materials and
forward copies to this Department to complete our files:
1. Well log fran well driller.
2. Bacteriological analysis of water supply.
3. -As -built plan prepared by the designing engineer or architect.
Procurement of these necessary documents may be facilitated by contacting the
well driller, engineer, former owner and/or .Town. .
You `should be aware that proof of approval of the sewage and ,water supply
facilities serving this property may be required relative to future sale or
refinancing of the property. Therefore, it is in your best interests to obtain
the above- captioned documents.
If there are any questions or this Department.can be of any assistance in'this .
matter, you can call the writer or Mr. Hodgens at 225- 3838/3833.
JK:mk
cc: E/A
J. Romeo, PE
M. O'Dell, BI (T) PV
File
ery trul 'your
hn Karell, Jr., P.E.
Director
Environmental Health Services'
F/l /Jk/Jay -4
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
L PUTNAM COUNTY DEPARTMENT OF HEALTH: iasr�
aiL<i
Division of Environmentaf Health, Services, I^ame % ".N, Y 10512
} Putnam galls i0
CONSTRUCTION PERMIT FOR SEWAGE,-DISPOSAL "SYSTEM :9
s7& r Village
icy y�y
tccated „>,r B9i�, J'yr e�t -+-�a —.a �:.q =ice �87F:6Y1d o _ v
Town
Subdivision
Lopez �c Graumann . Lot '20 yob
Owner Su9an ' B. Gr.avman Add► c o.'. Jack ' Gorman
Ranch 2 1/2-,Acres- free rows nam a eye
Building'.Type Lot Area
800 gallons per day 2000 +:
Number of Bedrooms Design FloW Total Habitable Space Square Feet
Separate Sewerage System to consist of - 12W Gal. Septic Tank and -LF', Of 241,'Trenches
Sheidon 'Gardner Stevenson; °Avenue
To be constructed by. Address
Water Supply: Public Supply. From
'`Peekskill, - N.Y. 105Ei6 � _
x AnderSon'Well' drillers
Private Supply to be drilled by
Address
Barger 'Street?utnam :Val ley, N.Y
Other .Requirements ,8, Fi11 .to be placed in front -of house .for ra%s ng Fade for septics
1 represent that I am wholly and completely; responsible for the design antl location of the .proposed system(s), sewage disposal system
above described will be constructed as showh,on trie app roved amendment there to and in accordance:with'the sia ions of* e u nam
County, Department of Health,' and that. on completion thereof a "dertificate of Construction” Compliance's ors.t ssioner of lieaI'thwill
be submitted to .the- Department, and "a written = guarantee Will..:be furnished the owner, his,successors,'heks - at said builder will
place in good operating condition any..part of said sewage disposal system.•during the period of two (� r ` d' I 'fo I, n".thedate of the issu-
ance of the approval of the Certificate `of Construction Compliance of the - original witem'or aey'iepay eto; dri II tlescri6ed above
will be located as shown on the approved:pian :and that said,well will be Installed 1n accordance with the sffir r' s, r Ufa 18433,0 of the Putnam .
County Department of Health.
oats Nvember 17, 1977 g..' .
e R.A.
Si ned
OW Address 1 Northrid a ad Peekskill N.Y.:. . No 0278146
g
APPROVED FOR CONSTRUCTION: This•approval expires one year from the date . .issued unless construction 8fcW b i,[�8Ols been undertaken and is/
revocable for cause or may be amended or modified when considered necessary- by .the Co — er. of Health. AnW RA- or aiteration•:of :con_structio�
requires a newl�permit. Appr9ted for disposal: of .domestic sa rry+s yage,la�ntl /or ,pr ate w r,su i5pplX only.
Date gy `C/ VI �► Title +
i
m
h
po ^A
A : Cp
V.
cbt�YAs
>.
PUTNAM COUNTY HEALTHFDEPARTMENT
L�`wa:.�04 - DIVISION -OF ENVFRONMENTAL sHEALTH SE &VICES
;. y.
r
J'o6 m. Simmons; M.D f :
-
Deputy...Comm ssioner of Health FIELD ACTIVITY'REPO:RT —
Sheet of.
-
INSPECTION
k
NAME Nei -AwSK { F
0rig. Routine
ADDRESS �_ iA `= siT' _4uT�►EJL&'r'
Orig.., Request
No'. ;,; ,Street Municrpalty (T
Compliance
• - -
:Comp
Y
MAILING ADDRESS,' -
.Compiaint
inl =` >
:F,.G, a a
.P.`0. B7ox lost,Offic de
e" Zip
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l
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to
onstruc ron
=TELEPHONE -
Reinspection
PERSON IN-.CHARGE: '4
_ .. e ,
F�.e.ld`;` .Sampling •'Only
:OR INTERVIEWED
Field Conference,
'Name and Ti`t e Q
DATE_ Or_. TYPE FACILITY
TIME ARRIVED LEFT
ai
Expin
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INSPECTOR %°�'« �+
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TE EPHONE
Signature aind Title f
PERSON IN CHARGE OR INTERVIEWED.,= ,
ow SIGNATURE r r
T acknledge receipt .of a copyt,of th
Field Actiyit Report, .. ...f fl
TITLE..
Gentlemen:
PUTNAM COUNTY DEPARTMINT OF HEALTH
L1'U :- ,:2zaRV-1C.E.S _ ." � -. _.. �...... .
4
i
Date November 3, 1977
Re: Property of Susan B. Graumann
Located at Barger Street
Section 68 Block 3 Lot 20-.,& 1/2 of 19
This letter is to authorize John S. Romeo
a duly licensed professional engineer x or registered architect
(Indicate).
to apply fo.r 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
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
. s s em ter - systems � �i conformity with the' -p11&v: s ores "of-, Arai c-re -145- or' '
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
P . E . , WA . , # 027 46 IAA 8 - 8182
Telephone
1 Northridge Road ( Sea 11 • ° °
Address �, E�phAl:E
•
S.
+•
Peekskill, N.Y. 10566 o�N �, !�•
s ,
737 ®1056
Telephone
Of
Very truly yours,
Signed
Owner 6f Property
Barger Street, Putnam Valley, N,Y.
• Address
s
Litv'lox
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