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631- 589 -8100
83.16 -1 -37
BOX 30
03900
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CERTIFICATE `OF CONSTRUCTION co
a -
Located at
ownerd.Tf2iCiG iV�o
Separate sewerage system `built by
Cohslsting.of, �U Gal Sept)
Other requirements
Water. Supply Public Supply From',
-Private supply, Drilled
f:
( Addressi���
Building Type w _J /IVCat? !-X1MiL1%
Has Erosion Control Been Completed?
I; certify ;that the;;system(a as, listed serving
:6f' which ' -are attached) z.LhC accordance with
: putnazu ounty Depastment'"'Of Health.
DaW
T.
Address
.. Anv'Derwn'oecuDvihe weinises serve&bv the` 6
t
M 'COUNTY) Dl
E rironmentii/ Heal
iR P
ink and
:,.ava�wu�e.gnv c�n.wpprvva�-.vr. ,,�na puvace water suppry sna n;vecgmenun; a�
subject to modification or `change' when 1nathe Judgment of the Com /mi
Date
nse No
,y 0 125 C2 ;i
cessery to secure,the correction cof any unsanitary
ite a. vi d void'as won ar a public sanitary sewer,.60comes
old, w afar supply'--becomes'aJailatiI Such approvals are j
per of- Health .such're io modif6tion or "chart =:neeesary.
i
Title '
�.r.
a- �e-w- •- .- vir ^+Y =' ti . - =max. 2 ate; �.-. � -vi. �.. , ^i > ". :.. .e.�i
a ►- :�.�. .�.. _ �� a.
v.. IwT Ir u�. ..� -.M.. :.. y.b ..
Owner or Pu c aser o
Building
Muni cipa
ity
I'M C ) C
RoG P
Building Constructed
by
Section
Location - Street
Block
Sl.,K167L E-
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 suc.ces-
sot-'s, 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 :Wade 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.._eonclusive.the _de
.terminati_o : Z-. the T7.i.•rec oii' o -i' -he Di- vis�ari of- Env roru�en� 1'heaZth °'Se-r
vices of the Putnam.County Department of Health as to whether or not the
failure'of the system to operate was caused by the willf or negligent
act of the occupant of the building utilizing the syst-
Dated this day of u4 __. 19 k3 Signature
Title
If corporation, give name
and.address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3)
CERTIFICATE OF COMP,ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE
COPIES OF FINAL PLANS BEFORE
OF FIRST US YSTEM...
AN
Division of Environmental Health Services, Putnam County Npa O of
11
Health
7
01
COUNTY
OF WEST(,
Results 'of Examination
A
Laboratory
by
Dd oil et
:, or Totals'
Free
'
J_
Turbidity, �
,-"BA' TERIJ
mne. per, 100-nl
The e e Was of c, sa -tl
e. S u ts�' irl fc6fo�,
S-
r
the sample °was .coltect
a
4
PLANT 1
4
40
t
M
kab
ucl�lpl J,
p
o-1
Units -,
.-,PH Value
octory ltyjo� 6.
bacteria u"-di for e,jnd-�
ise
7.
WELL COMPL:9TIOWREPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by..well Ar.iller. and submitted to- County Health Department together with- laboratory raoort of
^=' °`a�iaiysls'ofi irvaicr'sani�,ie i�7iii%atirig water "rs"of satisfactory bacterial quaiitybetore certificate of construction compliance is Issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
ME
ADDRESS
LOCATION
OF WELL
�g ( o.'& Street) (Town) 1 of Number)
-('G .•C v�tZ -G��� �G.�f -
jj��� BUSINESS ❑ ❑
PROPOSED
1?'J DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ ❑ OTHER
CONDITIONING (Specify)
DRILLING
COMPRESSED CABLE
® ROTARY ❑ AIR PERCUSSION El El
EQUIPMENT
((SSpe if )
P PERCUSSION
CASING
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER OOT
❑
MYESHOE
El
WAS CASING D7
O
DETAILS
/
THREADED WELDED
YES NO
YES NO
YIELD
HOURS G.P.M.
❑ BAILED F]
YIELD (G.P.M.)
TEST
PUMPED COMPRESSED AIR
WATER
MEASURE FROM LAND SURFACE — STATIC(Specify feet)
DURING YIELD TEST [feet)
Depth of Completed Well a
LEVEL
in feet below land surface:
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (inches) FROM (feet) TO (feet)
PACKED:
gravel pack (Inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
r
� _
Ap
OF NEW
(� ORE V � C�
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
ROFESSIONP�
DATE WELL C LETE
DAT F REPORT
WELL DR (Signal
/
y/y /
i
r
"7 777
C 9Y
inage 77
or
ar
e7 T41 -Area
Building: Type'. dt:
termine
)rivate Supply :to 4Y
Address
:c _D66artineint" -6i:` Health will'
be 'submitiail to" the da�aikment a nd' A written."guarantee will be he n or assigns by the builder 'fha6aid builder Will
id Saw (2
ance'.6f 'the. approval of, i'lie, qe�iif icate' of Coriitiuciion Compl i -C�e; _�T al t r hpreto�; 2) that the drilledwafl-dekribed above
will be located *as sh6wn on.the approved plan'and. hat said well wil 'install c a a rds, �rules -,an'+d'- re'gullt s qf,":. ffie Putnam:
Apri
an
4a I
le—
o
PUTNAM COUNTY DEPARTMiNT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date October 25, 1979.
Re: Property of Patrick M. Grogan
Located at Brookdale Road, Putnam Valley
Section 113 Block 1 Lot 3
Gentlemen:
This letter is to authorize Salvatore V. Riina, P.E. a duly
licensed professional engineer g or registered architect _
(Indicate.)
to apply fora 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 on my behalf in connection with.this matter and to
supervise the construction of said system or - systems in conformity with the pro-
visions of Article 145 or 147, Education Law, the Public Health Law, and the
Putnam County Sanitary Code.
Very truly - yours.'
Countersigned:
P.E., R.A., # 512
186 Katonah AvenA
Address
Katonah, New York
232 -7408 or 248 -5815
Telephone
Sig
y
Owner of Prop . ty
�Ly Ai0:';"'- Addres s
7 � r�
y Telephone
a
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 Patrick M. Grogan Address Putnam Valley, New York
Located at (Street 4Bdicate rookdale Road sec.,: 113 Block 1 Lot 3,
nearest cross street)
Municipality Putnam Valley Watershed
N.Y. City
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
... ALL TEST HOLES WERE PRESOAKED PRIOR TO RUNNING TESTS ,..
hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Dept Water Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1 11:15 -11 :28 13 18 21 3 4
2 11:29 -11:40 11 17 20 3 4
3 11:41 -11:52 11 18 21 3 4
111:31
-11:43
12
17
20
3
4
2
11.44 -11.55
11
_ 17
2�
3
4
3
11:`56 -12:09
13
16
19
3
4
4
1 11:50 -12:00 10 18 21 3 3
2 12.01 -12.10 9 17 20 3 3
3 12:11 -12 :21 10 19 22 3 3
4
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
`i. 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 SOILS ENCOUNTERED IN TEST HOLES
'
DEPTH HOLE NO. 1 HOLE NO. 2
HOLE NO. 3
Deep Test
ole
:= r..,.G.,I�.•..r B.kk< i_c t13k:. _organ is .r .
$1:k: �?c ilk o,r.,g�riic:
6" topsoil topsoil
topsoil
topsoil
12" sandy sandy
sandy
sandy
18" loam.,... _ :- -. loam
loam
loam
24" subsoils subsoils
subsoils
subsoils
3011
4211
48"
5411
60"
sandy,
66"
gravely
72"
subsoils
7811
84"
... NO GROUND WATER OR ROa< LEDGE ENCUMERED
...
INDICATE LEVEL.AT WHICH GROUND WATER IS ENCOUNTERED
NONE
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NONE
TESTS MADE BY Salvatore V. Riina, P.E.
Date October 24,
1979.
DESIGN,.:._
r Soil Rate Used 0 -5 Min,/1 "Drop: _ S.D.TUsable
Are u e�o 5,.00O
sq /ft.+
�
No. of Bedrooms 4 Septic Tank Capacity 1200
Absorption Area Provided By 333 L.F.x24" X
�'�oRE A onry
ti y��•h% e h.
.
.( one
Name Salvatore V. Riina, P.E. igna ure
Address 186 Katonah Avenue SEAL
Katonah, New York 10536
sFO 51"
FRGFESSIO ""-
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
380
N"
i�F- s � PE: SIC.E7
GAL CONK=
SEPTtG -rA tQ �K-
I Teo
�rEci �
1" 20
APPROVED
x1- IEU A-PA rE - /.2' G <7LS. !'E / {' ,5 ' % E' /: U.AY'
rfMUM OE,51C;Al A?A 1-6- r 300 GA-5. FIEF? SF P,E'A? I)A)-:
'TIC,"rAI,IK CAPACVTr= A/P 8iFO1?OOM,5 x .300 GALS. -.-ul 'A,S *
,4 Z- I-11VEAL rT OF Tl-?CAlrN z 3IS'L5 L. F rA k,-EA1 F/:POM 7-AeLE
ASr eEV1.9LF0
'IA4UA,f :VC-11 P/_P771-1 e4'� �F/lv'Ci4 141!D714 - ?4'
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