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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley
Oscawana.Lake Road Filed #1649
Located at jj;l�(Mep Block -
Owner Robenat Contractors Lot #2 Job S01807
Separate Sewerage System built by S -AF Septhc . Systems Address New Rochelle, NY'
Consisting of 1000 Gal. Septic Tank and 435 L.F. x 24" Wide Trench
Other requirements None
Water Supply: Public Supply From
X Private Supply Drilled By Mill Drilling, Inc.
Address M�
Building Type Frame No, of Bedrooms Three Date Permit issued —jL 11 , 1978
Has Erosion Control Been Completed? Yes
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans fil and the permit issu by 7Putnam County Department of Health.
Date 25 July 1978 certified by s P.E. R -A.
Address R•p• 9, a�" S eel, Carmel , N 10512 License No. 29206
Any person occupying premises served by the above system(s) shall promptly take such action as may be 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 and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the Judgment of the Co mission f ealth, such revo n, mo ification or change necessary.
t �2 By '�
Date Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
jrl Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM _ PUttldm Va 11 ey ° r
Fi 1 ed Town or Village
Located at Oscawana Lake Road XXXMap #1649 Block
Subdivision
Owner
Walnut Knolls
Robenat Contractors, Inc.
Building Type Frame Lot Area 1.472 A.
Number of Bedrooms Three Design Flow 600 Gal .
Separate Sewerage System to consist of 1000 Gal. Septic Tank
To be constructed by
Water Supply:
Other Requirements
Public Supply From
X Private Supply to be drilled by
Address
None
Lot 2 Job 501807
Address % E.A. Rader, Oscawana Lake Rd.
Putnam Valley NY 10579
Total Habitable Space 1092 on 1 " Fl . Square Feet
and 429 L.F. x 24" Width Trench
Address
I represent that I 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 Putnam
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 successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved,plan and that said well will be installed in accordance with the stand ar les and regulations of the Putnam
County Department of Health. �I
Date 1 May 1978 Signed ` P.E. X R.A.
Address
R. D. 9, Fair St ee Camel Y 1051 License No. 29206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only.
Date rT % / b' By 10at, d U41I1411 -m Title AOfF
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This _report _is to be comple,ted.by ,well driller.and submitted to County- Health. Dep rtment-tooether .with_.laboratory .report of__: , .:
aroai� Fs bf �,/atee s in(iie frf 6ating wlater is for saYlstactory bacterial quafity before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
ADDRESS
Oscawana Lake Road, Putnam Vall
(Town)
Putnam Valley
❑
NAME
❑
OWNER
Robenat
Contractors
LOCATION
OTHER
(No. 6 Street)
OF WELL
Oscawana
Lake Road
DETAILS
®
BUSINESS
❑
PROPOSED
DOMESTIC
ESTABLISHMENT
USE OF
YES
YIELD
WELL
PUBLIC
❑
❑
PUMPED COMPRESSED AIR 4 30
SUPPLY
INDUSTRIAL
ADDRESS
Oscawana Lake Road, Putnam Vall
(Town)
Putnam Valley
❑
FARM
❑
TEST WELL
❑AIR
LENGTH (teet)
❑
OTHER
� THREADED ❑
CONDITIONING
WE-CASING
(Specify)
NY 10579
DRILLING
CABLE ER
(Spe
❑ ROTARY El
EQUIPMENT
AICOMPRESSED
R PERCUSSION PERCUSSION if )
CASING
LENGTH (teet)
DIAMETER (inches)
WEiuHT PER FOOT
� THREADED ❑
DRIVE SHOE �j
X❑ ❑ NO
WE-CASING
Z
NO
DETAILS
255
6
17
WELDED
YES
YES
YIELD
HOURS G.P.M.
❑ BAILED ❑ ®
YIELD (G.P.M.)
TEST
PUMPED COMPRESSED AIR 4 30
30
WATER
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST [feet)
1
Depth of Completed Well
LEVEL
30
165
in feet below Land surface: 165
SCREEN
DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL
PACKED:
DEPTH FROM LAND SURFACE
FEET to FEET FORMATION DESCRIPTION
0 15 Clay and boulders.
15 165 14ediura —hard clranite.
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
Diameter of well including
gravel pack (Inches):
Sketch exact location of well with distances, to at least
two permanent landmarks.
J
i�
S* DS-
G
DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) > +
ILLING, INC,
Y
{
BREWSTER LABORATORIES
Box 224 - BRF:WSTER, N.Y.
WATER ANALYSIS REPORT
SAMPLE NO. ' 4 0 5 9
SOURCE: Eugene Rader well
Oscawana Make Rd.
Putnam Valley, N.Y.
COLLECTED: June 2, 1978
BY :Mill Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result
indicates the
source 'of
the sample was
of satisfactory sanitary
quality when
the- sample
was collected.
June 6, 1978
Roy it P. E.
Director
I
- w
3 .. __. ..:..,�.- ......y:-:<<,:.= r.�-. ... - ,,::.:,k, ....,.: "r;.::.. �:i,......- .rr_:...:r -i - •- ;.:.:.. �. ..a.: - .;•n! —. , ;.i.,
Robenat Contractors. Putnam Valley
er r Purc a er of Buildin Municipality
17- Fi 1 ed 'Map # 1649
uilding Constructed by Section.
0scawana, -Lake Road
Location - Stree -t Block
Frame #2
.Building Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
Ujr represent that (ONWwholly 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 '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 aS 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 of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused b the willful-or
Ni
act of the occupant of t uildi utiliz g th
Dated this day o 19:S Signature "
Ti t
corporation, give name
and address)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3)- -COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP.7,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
FIELD CHECK LIST -
Date , 16)1419
INITIAL SITE INSPECTIOI`1
Yes .
No
Comments
Property., lines .or corners found
Can estimate house location . . . . . . .
Will driveway need cut . . . .
Q
Must trees be removed -note these
Is deep hole representative of entire SDS.area
Additional deep holes needed. . . . .
Sufficient SDS area available considering
driveway cut, house location,separation .
distances., etc. . . . . . . . . .
.DEEP HO= DATA
Depth: +-
Water: elevation:
_
Rock elevation: "7' . :.
Soils descriution:
Date:
FINAL SITE D\TSPECTIOW Insp. by:
House located where shown on approved plan
SDS located where .approved . . . . .
Length of trench measured
Width of trench average
.Slope of tile line 'and. trench acceptable e
Room allowed for expansion trenches.
Over 50 ft. from swamp. watercourse . . .
Natural s�f3: net :.strippeu ui- SDS area
unnecessarily graded o
10 Ft. maintained from prop.line.and
20 ft. from house ' . . . . . ... :
Separation of trench from house, well
etc. follows plan
Number of bedrooms checks
Stories, brush., stumps, rubble;-etc'. greater
than 15 ft. from nearest trench . . .
15 Ft. of peripheral soil horizontally from
trench . . . . . . . . . . . . . . . . . : .
Junction boxes properly set.
Could surface run off from driveway, roads,
ground surface, etc.. channel near SDS . . . .
area .. .
_
Does lot draina ;e air -ear O.K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE
ncvlr.w �,ttlSl.Y. :Iil;ll ;J.
,M(.eLs Strl j Remark-*
.
:
. .
G9 O
1�
° �Y U ;.
;z �. . . _• =
MCC E ITS . ,.• . ..:.
�:.._ .- -,: �..,
muse plans 0. K.
f
Design data sheet
Plres presoaked?
,l ►
I%in - 30" pert test depth •
'
'Con4t . results for 3 runs
r
D.. Hole log O.K.
Corporate Affidavit for other than individual
I
Authorization for engineer
IFtter from Water Supply if applicable
.if variance requested -such noted.on -plans & apps..
a
D: AILS
_
if change is proposed,)
misting contours shown show new contours)
I Pot
Slopes for driveway cuts, etc. shown
Xater service line.location
Yopting drain, etc. location
Tod slope, bottom slope of fill
.Percolation tests and deep test pit location
.- Set"tic tank size and conforr:ance to std.
3 B.,R. house minimum
House setback shown
_Distribution box ftg. below frost
All -water within 5Q ft. of PL shown
Plan and profile SDS __ :.:. ✓..... 4_.
A:11_: o th-r: well s: =any -SDS .closer 2- ii? , I f t
shown.or reference made
Property boundaries (metes and bounds clearly s
�1
WARATION DIMOCES SPECIFIED ON.PLAN
.0' to P.L.
0''to Foundation walls
J' to Nearest well
0' to stream, march, lake, etc. incl.e
5' to Curtain drain
3' to water line (pits -2-0
;' to storm drain
' 'to large trees
)' from foundation to septic tank
to pipe from . leader drain & ,foo 'ing
:pansion
't
Ira�iri
,. ,
PUTNAM COUNTY DEPARTMENT OF HEALTH
CE
IT
Date I May 1978
,Re: Property of. Robenat Contractors, Inc.
Located at Oscawana.Lake Rd.' Walnut Knolls Subd., T. ';Putnam Valley
Filed Map #1649
Block Lot 2
Gentlemen:
This letter is to authorize John-H.. Prbntiss, P.E.
.a duly licensed professional engineer x or registered 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 promulagat6d 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
system or systems in conformity with the provisions of Article 145 or
1.47,1. Education-.Law,_ the. Public Health:. Law, and the -Putnam --County-Sani
tary Code.
Very trul :(o urs,
Signed
Co tersigne
P '
n v D
.E . R.A., #29206
HUMMUZU R.D. 9, Fair Street
Address
Carmel, NY 10512
914-878-6170
Telephone
0 ESSIO)V41 PRF FAG,
*0. 29
OF TPAE 91
Os a*" L� Ee PK6W r ty
Putnam.Valley, NY 10579
Address
9,14-LA8-7664
Telephone
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PUTNAM COUNTY DEPART M'P OP HEALTH,
DIVISION. OP ENVIRONMENTAL HQMTIi 'SERVICES '
- ,OUhr 'tFFIOE HUTLDTi`JO, CA R:l,o . Ne Y. 70512 ;
1 SBEET- SEPARATE SEI IAGJ� DISPt Uw 1sys- Tu FIX$ HQ Q
•$4 r0dd �l.�l�s'.E�f�G� La.�.► �.
6t (street) rte: Block
Ina
ca, a pe4rost cross s F807 War '► /dam.:; r "ti
Watershed t ,►
SOIL . COLATION TEST PATA RE UIRM TO BE SUAMITTED WTH AtaggAVZ
-LPM=LATIQW b PERCOIATIOV C ap p o water water !gym Fi►►om 'to Surfeme in Inahea . . v
to
rp in.Start -St ®p Start Stop d oop /
Inches InchQs Inches:.
!
® 2�
nic
IL 409.
A 9L
`r..
Hat,!e1�/1d���. : 1) 'fasts to he repeated at same depth' unti X a .. root ®I lual
x i1. MM W obtaaod �,t each pQi'cQlt3oa� toe$, k�Q�p �l�l �a' t ®® ,
,
A. ,
QUlmpth nioasurementa to be ,made • fr ma top . sag hole o '°.1'
i
DEPTH
T.E,ST PIT DATA RE-QUIREfl) TO Pl�: 1,.'1rPJT APPL-I.-CA'TION
011-1 B01L."',
1-im-L', NO.
'611
1211
241.1
3011
3 11
6 alp Latm^�-
teg
4211
4811
5411
60"
66"
7211
78 ti
84 if
INDICATE LEVEL A�?�1ILI xROLTIM IJATER IS EYC0'LT1,1THRE--,-) No ov Lo
INDICATE LEVLL TO WflICH WATER LEVEL RISES AFTER PLE, '.-P vTG ENCOURTERE D Aobve
TESTS MADE BY
9. rj 4L1.% 2 1;,A A
, Date _161
DESIGN
F)oi!,Rate Used/jUp min/1"Drop: S.D. Usable Area Provided 0
No. of Bedrooms 73ope Septic Tank Capacity /60g? Gals. Type
Absorptiol-i- Area --.Pi�6-V-ld—ed By_+19 L.P.x2ll-" width trenc h.
Other
90fESS1 44
Fflo or - 7.7 t C,
4
Address Pair Str,�v ,it
l
77,7 F,175,17-
THIS SPACE FOR USE 13Y 11EAU.1111 DEPARTMRTNIT
0
7,�bod
0'0
Soil Rate Approved Sq. Pt/Gal.
Chi�T
Date
4