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PUT\a�i CC.`;'?Y DE "?�` <T OF == .LT, -i 15
DI ISiO�\, 0 ! �:�/17(J���.r =� i � t! -'LTA '7l CES
DESIGN ij1T.? SHEt SE? �.:�:TE SEW aGE. D S =,OSaL SYSTF' FILE \0.
\z:9q S C3 R% vEs:�vt
amer aizev &A a -a y At' Address 13 t<nt' -s ,�j 10416
-ra x -aa -rAx
Located at (S _rep �). !Er ieL c5`rC ! o AD _ (� Block_ Lot �
(Indicate - _Est c ..ree �)
Municipality P��- ,�ao.a�l �AL��'1► Watershed .'E316ls1ii�'o��
SOIL PLRCOL TIO�: TEST D Ta PEOUIP�,D TO BE SU =VT__ED .•.IT:H ?.PPLI ATIO`
Hole
i�L'i LJc�:' CLCC:� TI`rE PE ?.COLA ,IOC: PERCOLAT C':
Rin Elaose Dep _'- to cer ;�:oter Levu
No. �lfi:e FrOT. Groura
S--:z- i° Inc- -s Soil
l Ras .
Stara to[i '!ir.. Star _ Stop E) o? i; fir ✓in . _ o�
Inc _s Ir.c Ir.c ^-s
1 1 G 16 Q `,�o jQ. �® ZZ 3 S
r 2
ct :-�
' q .4�3 ..
► `3
20 Z 2.
1 -
3
G : 4,S
in) C3
I
4
Notes:
1) Tests to be reoeate.' at.sa -e deoth until aooroX=- 3selt' egael So_1 races are ob-
tain.ed at e ch percola _'ion test hole . all data . t0 be SL'o- iit.teU f0� r2L'le:.
2) Depth me-ents to be -made. from top of hole.
36"
66"
iL"
0 �-v ov
Name e �y�.ti ►yi�r� Sim afore 0 s 61, _
°
Address SURIVAH = THIEDE : * :
_ e A D°
CLARK PLACE zo o
P.'D: B��_ 3[18 q 14 6ZB -% -I-- �?� ,►, ..� =
yuu a� V V -00 ".. [-FO- e0 �1v
PliT`A`I CO Qi$ '_ F `�i 1L L 11 OF rt.ALT i ��,R�FESSIONP
- sd�eeueaniee�
Soil Pate roved. Sq. Ft. /Gal. Chec':ed b-:6 _Date
IN LF�LL
Ty J, IS E�:000I TER =�. Grew p
AT`T;',IC r G ROUND �e.+b �E®��
u /LT£�
INDICATE L iLL
TO Sv;iICH ::ATE LEA L RISES AFTER 8-7_ C, E`COJNT -RED
TESTS `LADE BY IVA Q— "I4E®iE Date
y�_
Soil. Ra.� "s1
Ni :,!1` DrcD S.D. L's��Ie :?rea °:o. -gip.; S
'
No oI Sed_ oc -:s
�-- SeDLic Tar CaD _c_t; I, Z o ® Cals • ZYDe
lea ASe�y� w
Absorption 2c
RroV1Ci?C EyX4'6- L.P.Y?`= 36`' e1 G:1.µ�h tre:,cn.
OT:iZ -O�' —
*erf„ Of N
0 �-v ov
Name e �y�.ti ►yi�r� Sim afore 0 s 61, _
°
Address SURIVAH = THIEDE : * :
_ e A D°
CLARK PLACE zo o
P.'D: B��_ 3[18 q 14 6ZB -% -I-- �?� ,►, ..� =
yuu a� V V -00 ".. [-FO- e0 �1v
PliT`A`I CO Qi$ '_ F `�i 1L L 11 OF rt.ALT i ��,R�FESSIONP
- sd�eeueaniee�
Soil Pate roved. Sq. Ft. /Gal. Chec':ed b-:6 _Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
V
- -,_— ,.CERT4F_),CATE- �OF- 60NST- RUCTION COMPLIANCE- -FOR SEWA(3E4U'SPOSAL- SYl TEM -- ,LA,17 -;V, %6'').' )/At;Z
Town or village
Located at IIIC% / '!7 4se6ion Block
Owner- iii ✓ R % Lot Job '
Separate Sewerage System built by 1�. AI-AZ i':rrQ Address
Consisting of 1Z Gal. Septic Tank ;Z4941119 lineal Feet X -A%P� width trench
Other requirements
Water Supply: Public Supply From
Private Supply Drilled By iOML/ J. dlLA--�
l Address `'
Building, Type J °��� %�° �w����lL No. of Bedrooms— Date .Permit Is
Has Erosion Control Been Completed?
I certify that the system( as listed serving the above premises were constructed essentially as shown n the pl
attached), and in accorddanc r with the standards, rules and regulations, plans filed the permi issue t Putn
a
Date Gi`/i:/ ��1 -� Certified by
Address
pies of which are
rtment of Health.
P.E. W R.A.
ce'nS
1 9�
B,No. IC40
An person occupying ., es , s
Any eying premises served by the above system(s) shall promptly take such action as may be neiesi.iry,to secui@,,lhe correction of any unsanitary
�.....
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void7p 'sog n`. sue, :Npublic sanitary sewer becomes
available and the approval of the rivate water supply shall become null and void when a
p public water supply'tieEtime's�available. , Such approvals are
subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary.
Date !���" �� z B it le
Owner or Purchaser of Building 'r
I IlO40 (+Ot3
Building Constructed By
Location — Street
Building Type
'aI7�NAIOV
A'°unicipality
Block
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
61 Co
I represent that I am wholly and completely responsible for the locations
workmnships materials construction and drainage of the sewage disposal system
serving the above described propertyy and that it has been constructed as shown
on the approved plan or approved amendment theretoy and in accordance with the
standards' rules and regulations of the Westchester County Department of Health,.
and hereby guaranty to the owners his successorsy 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 completion of
the sewage disposal system or any repairs made.by me to such systems except where
the failure to operate properly is caused by the wilful or negligent act of the
occupant of the building utilizing the system.
The undersigned further agrees to accept as.conclusive the determination of
- the -D-irector,-of--th&-Division of Environmental Health Services of -the , estchester -
County Department of Health as to whether or not the failure of the system to
operate was caused by the wilful or negligent act of the,occupant of the building
utilizing the system.
Dated this Z& day of /nom 19_!,4
at 1"'ob �OwLc /u,
Place & State
Title 12re#& /J1,g1hW oc V,l
(If corporation, give name and
address)
FIVE (5) COPIES ARE REQUIRED WITH FIVE (5) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FII2 NOTICE-OF DATE OF FIRST USE OF SYSTEM
--------------------------------—---------
Division of Environmental Health Services, Westchester County Department, of Health
Form S.D. 50
January 19 1960 (1972)
WELL ,COMPLETION REPORT. PUTNAM COUNTY, DEPARTMENT OF -HEALTH
1/71 Division -of.Envirohrh.ent.1,H.ealt. iServices
COUNTY OFFICE .BUILDING -,.CARMjgL;. NEW YORK
Health Department together with laboratory
ffi s report is to be Mplaiid'6ywe d-rilheir"iand 's 'u'b'm"itt"e"d"t�o�'" County .'report- of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance'is".issued.
F-REPORT M U.1>T BE SUBMITTED WITHIN 30 DAYS OF WELL C'0'M'PLETIO'Nj
OWNER
NAME
b�-komf�;- I 1
ADDRESS
11 q�
NY
LOCATION
(No. 15 Streell). ( wn) .(Lot Number
l.
OF WELL
F _&T
BUSINESS
.
❑ El
E6
PROPOSED
DOMESTIC ES7ABLI SHMENT FARM TEST WELL
USE Of.
WELL
PUBLIC AIR OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑
(Specify)
DRILLING.
COMPRESSED CABLE OTHER
10 El 1:1
E12UIPME GIT'
ROTARY kilt PERCUSSION ❑ PERCUSSION El (Specify)
CASING
LENGTH (feet)
DIAMETEF: (inches)
WEIGHT PER FOOT'
D V H
nES, OE
FIND
WA3'CASI,NG UTED?
DETAILS
THREADED [:1 WELDED
YES
YES LJ NO
YIELD
HOURS G.P.M.-
❑ ❑ 19
YIELD (G'P.M.)
TEST
BAILED PUMPED COMPRESSED AIR
WATER
MEASURE. FROM LAND SURFACE (Specl!y
YIELD TEST fleet)
Depth of Completed Well
LEVEL
- 1
0" -t-
F
in f surface:
eet belo W La
-"KE-;:, -
LENGTH OPEN TO AQUIFER (feel)
SCREEN
DETAILS`
SLOT SIZE-
DIAMETER (inches)
GRAVEL SIZE (inches) FROM (feet) TO (feel)
IF GRAVEL.
Diameter of well including
PACKED:
gravel pack (inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
7-isWe-ti-h exact _Idcatl6W�.IW16WHI, lances, to, asi
at 4
a.
FEET
EET to
A/4 rel j2'a
S' v
-v
7
Z
7
C�
�A.
If yield was tested at different depths during drilling, list below
X
FEET GALLONS PER MINUTE
4
"1., 7
DATE WELL COMPLETED
DATE OF REPORT'
WEL
5/ Zz
A
511
610
YORKTOWN MEDICAL LABORATORY INC.
I',Q:..3ox 99 321. Kear Street
Yorktown "eights, ts, N.Y. 10598. - 245 -3203
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
F
DWNER DATE RECEIVED -
r v A 17PIq 3/19/73
CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED
10 8 GRANT AVE BRONX N Y 3/21 /73
1 q
5AMPLLNG POINT
LL- FIELD STONE RD. PUT. VAL> -MAP #1 OF GLENBROOK PARCEL -TAX MAP 66 -TAX LOT #1.
BACTP -RIA PER ML. (Agar plate count at '35 C). COLIFORM.GROUP (Most probable N6. /100ml.) HARDNESS, TOTAL -ppm
LESS THAN 2.2
DETERGENTS - 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 sample was col cted.
z
'jL
A. H. P.ADOVANI, M. T. (ASCP)
m
CE Ifi
17 i e:F
vi
%F r
at� w_,jr
In
A
n5
/450
ep,
00, 0e� A CONSTRUCTED." -CONS Ug,.E.D.
SEPARATE.SEWAGE:01SPOS41st
PPROVED
TOWN: bf.:
. .. . . ......
PUTMAK COUNTY DE�Tff _4
ti;LON'SEPTIC TAN SULLIVAN -
TRENCH UMMUNINUNTAL "EALTH SERVICO CONSULTING ENGINEERS:
I ct A
I
ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE
' TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL
SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO 'CONFORM TO STATE
,.. AND LOCAL STANDARDS AND REGULATIONS .........
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AUG 19
.✓o>ef:•
PUT COUN ENT. Of H ALTH
ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE
' TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL
SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO 'CONFORM TO STATE
,.. AND LOCAL STANDARDS AND REGULATIONS .........
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�09TdM /S ASSUMED
o DIRECTOR, DIVISION OF[M
' s ° c9.z> /.ae.✓ Pima'
ENVIRONMENTAL HEALTH SERVICES {# �• =� `,� -�
ONE > r -
'�- ➢tea /.CY
Y• _s,
S f , S//.Gt / ✓. Gam✓ P E.
.� /F. .✓O. .2fB9S
¢ t � -✓cr c-✓ BoX S�'STEM .S.f�.4,C .G- CONFO M
yam`':.PE6:1 .9r .✓ ., • • • • •
- _4 "� =P %E" O.a T.S/G /°UT- ✓./%,n•9. CO//.✓'TY .��P11Cl t1 hr�w',�`•'�
`9.e�.POx, -E'x /3 T. G.�9DE �YE.�.G T/!, SE.G ✓ /CES, �N ��'
24"
SOIL PERCOLATION RATE .............. S . MIN/IN / „200 GALLON SEPTIC TANK 1 , "v . . `-
DEEP TEST'* ..✓o �.rou.✓p r✓Arer.P ;. ,TP
�oLdrpGEL°pc.C240 LF X36 ABS. TRENCH
PROPOSED
SEPARATE SEWAGE DISPOSAL SYSTEM
s/6.PO Md � YiiTE`S
Fit Go STO/✓E .Pd'/Os7
.O.v,�CE.0 .✓o �/
TOWN OF Pvr�voM ✓-g<,cEY
OdTN.9M COUNTY. NEW. YORK
DATE 7_,?9 -7i SCALERS -✓,llj JOB NO. 71- /03'
SULLIVAN - THIEDE
CONSULTING ENGINEERS
CLARK PLACE
NEW YOLK
_ -------------
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�09TdM /S ASSUMED
o DIRECTOR, DIVISION OF[M
' s ° c9.z> /.ae.✓ Pima'
ENVIRONMENTAL HEALTH SERVICES {# �• =� `,� -�
ONE > r -
'�- ➢tea /.CY
Y• _s,
S f , S//.Gt / ✓. Gam✓ P E.
.� /F. .✓O. .2fB9S
¢ t � -✓cr c-✓ BoX S�'STEM .S.f�.4,C .G- CONFO M
yam`':.PE6:1 .9r .✓ ., • • • • •
- _4 "� =P %E" O.a T.S/G /°UT- ✓./%,n•9. CO//.✓'TY .��P11Cl t1 hr�w',�`•'�
`9.e�.POx, -E'x /3 T. G.�9DE �YE.�.G T/!, SE.G ✓ /CES, �N ��'
24"
SOIL PERCOLATION RATE .............. S . MIN/IN / „200 GALLON SEPTIC TANK 1 , "v . . `-
DEEP TEST'* ..✓o �.rou.✓p r✓Arer.P ;. ,TP
�oLdrpGEL°pc.C240 LF X36 ABS. TRENCH
PROPOSED
SEPARATE SEWAGE DISPOSAL SYSTEM
s/6.PO Md � YiiTE`S
Fit Go STO/✓E .Pd'/Os7
.O.v,�CE.0 .✓o �/
TOWN OF Pvr�voM ✓-g<,cEY
OdTN.9M COUNTY. NEW. YORK
DATE 7_,?9 -7i SCALERS -✓,llj JOB NO. 71- /03'
SULLIVAN - THIEDE
CONSULTING ENGINEERS
CLARK PLACE
NEW YOLK