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BOX 31
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03974
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TUT
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S77 ►Wat
L oeat 6 6 a t WAIA"'
e
Sewerage'. System built ,Eby
'
Consisting. of d Gal. S. .4 i p't I C,
',Qther. requirements
-'�'Waitidr Supply 6611c iSupiil�,:-From
it � Privat Drilled,
Building. TYPe 4.
2'' V,/d Ve
$'
Hasr E ►OSlon Control Been Completed?
T"
-
&�.certify' that ,t.he:sys. erq(s)�,as,listed
- se-, 46g'i"h e"a"i
and in accordance .wit
�h.' the "stadar'
-Address'
A py�p_er,.so.,np '
cj;upy1qg.pr
conditions ;res from
,such .usage Ap prp
aF,oi the priva elwa er,
':iijiilabW andil4e iupp
subject ;to '-- �iii tion 0r'..' c fiange wlia , n'.' t- 'he"-j
— -
rvfr
is
A
NY'
-Di6
CarM
is
1:P'. '-Town, or' Village
5 F-
ck Fib
Joti
widthtienc
Y'
B rooms Date -P.&Mit Issued
1�'
sen 1 the plans of,the,6610160d wo.rik';(coples o f whi h are.,
;°the permit ssup DV A nVPu tnim County Dp a
rireni of"-6ilth.
yl- A.A.
'A
I Icense...
may e,necqssar! unsanitary
to secure correction of any
ystem'ih'all-3'6cofi
e!null -and void as as ;.a ,
p66lic SaN , a
ry
sewer
60c
omes
id when 'public : ecpmqs,av allable Such:" approval s are
issloner of Health, h r tion modification -'or ,,change ,I s '-necessary.
T'Itlb
NY'
CarM
1:P'. '-Town, or' Village
5 F-
ck Fib
Joti
widthtienc
Y'
B rooms Date -P.&Mit Issued
1�'
sen 1 the plans of,the,6610160d wo.rik';(coples o f whi h are.,
;°the permit ssup DV A nVPu tnim County Dp a
rireni of"-6ilth.
yl- A.A.
'A
I Icense...
may e,necqssar! unsanitary
to secure correction of any
ystem'ih'all-3'6cofi
e!null -and void as as ;.a ,
p66lic SaN , a
ry
sewer
60c
omes
id when 'public : ecpmqs,av allable Such:" approval s are
issloner of Health, h r tion modification -'or ,,change ,I s '-necessary.
T'Itlb
t
R,KC-ii,�
-AL"LABORAT
'Ut ]
YO
OWN-VER IC,
RKT
1:�'I'O.:�Bdi"991-`,121, Wflt
reit
44-616W. l45 -
BACTERIA PER ML-,-., (Agdr plate count
f7,
HARDNES:S;-,T.OTAL PPM
'kSUL
;;-
DATE C ELECTED
—x
s- OF EXAMINATION CW ''�mA
16.
' TER
DETERGENTS
:NITRATES
:)WNER--'-
IRON, TOTAL ppm
7
MATE iREC EIV ED'
�j
TT '�` .. . ... ...
GAR" I, I Z R, ' ObT --1
4
CITY, YILLAGE�'TOWq "VORIN AW 0 F -SU PPL N
DATE REPORTED' N
k-101 -IjUTNAM
PLING?OINZ,
S
BACTERIA PER ML-,-., (Agdr plate count
COLIFORM �GROUP, (,MpbVpobdble, No ./l 0 Orhl.)
HARDNES:S;-,T.OTAL PPM
;:-A
'ES -'THM: -2 -`2.
DETERGENTS
:NITRATES
IRON, TOTAL ppm
7
tt
F7LOURPE,(f):-,Og-/L'
S
These results -frdi cotd�thcd the Water was
of it y -qu 1h be 1i ple was c ed.
J.
DOV.ANI, ..'(ASCF) -�illl
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mi
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
yy
Thrs' repo%'' fsto�be�icimpl�4ed�} rwePi° �df' illEr�and�sr�bmittedto��Co�rnty �leaitih�b' e�pa�fii' ierit °togeth'er�al�ith`�'8ff6�8tory re�(frtTf",`"
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
rA
I
NAME
ADDRESS
OWNER
EDGAR LITZROD
OSCAWANA RD. PUTNAM VALLEY NEW YORK
LOCATION
(No. fl Street) (Town) (Lot Number)
OF WELL
OSCAWANA ROAD PUTNAM VALLEY
BUSINESS
❑ ❑ ❑
PROPOSED
OMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING (S(Specify)
DRILLING
❑ ROTARY A R ❑ El OPHER
PMENT
EQUIPMENT
PERCUSSION PERCUSSION )
CASING
LENGTH (feet)
61
DIAMETER (inches)
WEIGHT PER FOOT
❑
5
❑
G
DETAILS
6
19 #�
THREADED WELDED
S. NO
S
NO
YIELD
HOURS G.P.M. •
❑ BAILED ❑
YIELD (0'.P:M.)
TEST
PUMPED &PRESSED, AIR 6 10
10k
WATER
MEASURE FROM LAND SURFACE —STATIC (Specifyfeet)
DURING YIELD TEST feet)
1
Depth of Completed Well '
LEVEL
15 feet
145
in feet below Land surface: 145
MAKE
LENGTH OPEN TO AQUIFER (feet)
NONE
NA
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (Inches) FROM (feet) TO (feet)
NA
NA
PACKED:
gravel pack (Inches):
NA NA NA
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
46
Sand,gravel
cz- U_
46
.85
Light.grey. form.
... ...... _...
85 -'
145,
Dark _grey farm.........
:...
V. .
�tw S L
f, - . r
1
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
145
10k
DATE WEIR 4OMPIETE
DpT�p6XPORT
WELL DRILLER (Signature) BRUCE W. WRAGG
mac
rA
I
—
Owner or 'Purchaser of building
a
M
d7/it% 6 144G�.
Municipals -y
.•........•.^.. .•.. _.. a.�f�...'�v.'4�� •.i••. C'- -•.•.r �oViT�W'P >f'� ^ {'4. .f 0• ^O RM A'�c9{.M :ON.. OC ..P -.. ;�. q•'• [ �,`p�P'.M'fii �1` ^; .. _
;ZG�2 ire,¢ o ar //.
Building Constructed by j,g.x
Location - Street
a
Building Type
o/
Block
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 successors,.'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 tTA7o
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 occupant of the building; utilizing
tj1 a P11P --nm
The undersigned further agrees to accept as conclusive the determination.'
of the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused -by .the.,will:ft 1, or - negligent act of the occupant of the building utilizing the.
system..' `
Dated this ; day of 19� Signature. AUU111
Title 6?Gc1A451e -.
(if corporation, give name and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE
OF COMPLETION WILL BE ISSUED.
GUARANTOR TS. REQUIRED TO FILE NOTICE OF DATE OF FIRST USE. OF SYSTEM.
Division of Environmental Health.Services, Putnam. County Department of Health
W,,
PUTNAM COUNTYDEPARTMENT 'OF HEALTH Y
J
..: • {
�' 3r Division of Environmencal rHealih' Services Carmel ; N' Y 10512
CONSTRUCTION PERMIT FOR SEWAGE. DISPOSAL SYSTEM ��V1 �7�j per'
Town
or.-Village I
�. -:,L vas .r, ..J fY l/I[L�F n" �: aI�/ '%s� r�.yy� ..;e -:.d •lus.. -�.•. f ..i• i�'y'? V'. iias rs. c *r r� x it rr c i,•, '
Located
,Block
Subdivision Lo'i JobD/�
Owner Ca `�9 r+Z. < n rang °�� Address �E'O' 3 �Io,(
Building Type 1s, /n% //tiL =1 LOt Area:
r
Number of Bedrooms -•� Total Habifable
e 5 _S4uare'Feet
Separate,Sewerage`System to consist of��' Gal Septic Tank �` + ^% -lineal feet .Xr T ��+ ` width* trench - '!
t +•
To be constructed byrjrrrl► /���'� Addresst% /% a'/+L�'� /� �Yw- j
1 Water Supplylic Supply From
;Pnvate- Supply to be drilled by
, .
NtaE a,cr%
•
'Address• -
LL
Other Requirements
I. represent thatl'am wholly and completely responsib of '.th c n of the proposed system(s)p 1) that the separate sewage disposal system
I
above described will be coristeucted':as shown on the' ad apS n m nd in accordance with.the standards, rules,an regulations o e Putnam
county Department of ,Health, -and that;on com � - onstrucUOn Compliance' satisfactory to.tha Co mis ;lonerbf Healthwill, "' )
Lie submitted to':the Department' and a `wntten fEr�e w 11 e r sh wne� his successors fieirs'or a'ss� ns b the builder; that, said builder will
Dui r� 9 v
place in ood o eratin condition an '`
9 P 9` - y'.part of" wag .thSpo� em the period ofawo (2) years immed�atery- ;following theidate of the issu =,
ance of ;the a k�c "
pproval of ,the Certificate of Con uct n nCQ18tiii a he "lg I system;or any repairs hereto;,2) that.thesdrilleq� well described above.. -11 u
o
xµwill be located as'shown on the approved plan and' id'w II ifi b ed p ordance n -the st rds rules and regu a ions of ;the Putnam.
wCounty. OepartmeM of Health
. �YY
Address "• �� /� �� '7
Li6ense No Z? .
APPROVED. FOR;±CONST;RUCTION This approval expires the date issue ..unless construction of .the.bwidmg 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
regwres ' ew per t Approved fo`r disposal of domestic sanitar.y 6ewage antl %or private water.'su I ' only.
PP Y y
Date • .:9 '
t By
l
L �
w
.q..... :hri �.. :.:.�..aa � .->aC .yr ,.c r+R•. -, e+ s-. ..; Cm�.av^cst.�c+. ^ r "...,,- - � .. .,.. a�r.+a' �. ...- r: �. .wr.Rrl �@ %ib �:• :, '..:..qr.;:c „ -Q Y� r.. -s
POT' A9 �6MV�- DEPARTMENTf 'OF�} •HEALTH �<
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Res Property of c g,_. L tr Z A Q p i
Located at O= A WAO A '
A i4 A -0 kga° a
1 Block n t Lot -
Gentlemen:
This letter is to authorize STANLEY �� ®��
a duly licensed professional engineer or registered architect
(IndicaTe
to apply for 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
1JGjJCLrt 111Gl1t Gf HecLltll, and to sign all neuez36ary 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
147,' Education'l�, ',' the 'Publi'c Health Iasi, -arid 'fhe Putnam CountyV}Sani
tary Code.
Counters, .
Very truly yours, 7
Signed 46A,
Own of roper y
it V
9 '-� �O < / a-7 A &Uy
Address
s 9 76
e ep one
a--
:PUTTAM „ COUNTY :DE.EART•MENT, 0F._HEA -LTH,
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE . NO.�
Owner �'o Z.1r�i�odT AddressR,90� , A-,c /079 ,10, -•ate /1411 -��
Located at (Street ,v LA a/9J� 2M . /.� Block C�/ Lot
_5� w
indica e nearst cross street)
Municipality. 16v ,4� Or z�Ti✓ dL��;;�, Watershed PE,cz�ic� , 4,J XrE'aa.rr`.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
apse
Depth to Water
WaUer ve
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
f / 1
922 2 =32, f�
3
2
2,'3 9 .s�
1
3
d'• v
ZS�' zs'
LfP
21
.7
o- Z
4
Notes: 1) Te'�ts to be repeated, at same depth until approximatelyy equal soil
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.
Mo
TEST .PIT DATA REQUIRED TO BE ' SUBMITTED_ WITH APPLICATION -
..... »,_ .. T. = DESCRIY'P1.0N OF SOILS �'NGOUiV� t' lb 114 TEST orlgS�`:n
DEPTH HOLE NO. HOLE NO, 1L HOLE NO.
G.L.
6"
1
2411 lj
3011
r �►
3 6 11 ,Q
42"
'1
48" �
54 �
.6011
66"
7211
78"
8411 a
INDICATE LEVE L"-AT -WHICH. GROUND-WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WA T R�,�EL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY C. � Date- 110-73
DESIGN
Soil Rate Used / Min/1 "Drop: S. D. Usable Area Provided or
No. of Bedrooms Septic Tank Capacity 67,0z> Gals Type Ire c 4zc-
Absorption Area Provided By-.3/ L.F.x2411 3b �v; width
A NNE R Other
Name P, w. Signature
A
Address .r..wanna, er m V I. ;01 L
THIS SPACE FOR USE BY HEALTH DEP
Soil Rate Approved Sq.. Ft/
3
Date
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OR. OIVISION OF {1
MYtRON4 lN74L HEALTH SFMW I
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