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BOX 31
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PUTNAM •,COUNTY DEPARTMENT OF "H ALTH
- E
.Division of Environmental Health Sewices Carmel N Y J0512
1 FRTIFIC/ TF_. OF C.ONSTR.tiCTION X.OMPL,IANCE FAR ��Wl4C�F �;,ISF ^S4L' S 'ST�!9% Tvts
pp
BlockW �
n or Vllla
v
,
6.:_ /LC ® .: `y Lot,
•
,Separate_. Sewerage System, built by ' Address ura� �-
h
O
iineaF Feet.X width trench
Consisting, of ®�. Gal. SePtic.Tank / �
-
�
Othei. r ' 6iments.
A
mac. -*Al tta � ;.
Water Supply Public Supply -From
"Privafe Supply D �Iled By 8
Address i
Building Type / No of Bedrooms 'Date ;Permit Issued
Has Erosion Control'Been COmpieted?
r{`i
f' certify, that the'systeni(s) as listed serving the above p c'onstr fly as shown.on the pia of the completed work, (copies'of :which are
attachedj, and Iii accordance with'the standards rul n d the ` permi4 -i ued 'b the Putnam County, Department of Health. j
Date I� -7``� o` ✓ P.E. RA. I
4
Address Licens .No
y% person occupying, premises served by the,atiove.s a <$Ma Lpro e_ ch,action•as mey be necessary to secure the correction of any unsanitary
' •. roval of t frly✓ shall.6ecome null 'and void as soon as a
conditions resulting from such `usage, App., public sanitary sewer becomes,
,available and the approval of, the ,private water supply''sh o n d when .a,.pu is w ei supply becomes available. Such approvals are
^subject to modification, or change when, in the:judgmentY�ner.'of Health,Health ch rev cation lfication= or:change.is necessary,,,. 1
Z�Date BY
Tit
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PEEKSKILL MEDICAL. LABORATORY
1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1
Peek lull,- New York 10566 _ _
) PE -7-8777.-
- t'.-, . i. ,V f -.. tl . ... � w �../':�'Ha A � .n.. .in ... 4 •'il G �W�I
DATE COLLECTED
RESULTS OF EXAMINAT60N OF WATER
OWNER DATE RECEIVED
�.�iA -0 2- 7V
'CITY, VILLAGE, TOjOWN. & /OR NJAAME: OF SSU,PPyLY � v DATE REPORTED l/
111-1Z
BACTPERIA PER ML. (Agar plate count at 350C).
COLIF %RM GRO P (Most probable N6. /100ml.)
R N S, TOTAL - ppm
DETERGENTS-ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm
FLOURIDE (F) - mg. /1.
These results indicate that the water was IMS of a satisfactory sanitary quality when the sample was collect
aVE'i,L 17 ILLS;: S LOG AND PS—'y!J �
i•- egor rlace city, village or,(/own
Owner P.O. Address
_
s �
Depth of we Le, i iameter 6 as well aisinfecteU? ``TTQQ� c
ft. in. gpm yeisror no
Amt. of casing above ground If Below ;:round Z., �Icll seal
' in ft packer, cement, grout
' r
.draw a ,: ;11 diagram in the space 4
i g p provided below and show '::he depth of ;
:c sing, the w::ll s,al, kind and thickness of forma;
U.,:ner. or lUrcllase).� of building Mu>>icipal.:i ty
< - - - � - _- _ - - - - -,. - -.:'7 . ,:: .: �'•. a .. �: � • ,''�F'. ..- jam:''' «. •.:
]suilcli�,b Con:�tructed f,y .�.�,c�i�i �;�x /ice • °
°
L 6
Location - Street
0
a
... S 1U�d..1{ 1 ✓ #� '
Building Type
-
Block
Lot a .t
GUARANTY OF SEPARATE SEWAGE SYSTEM 1 ;
I represent that I am wholly and completely responsible for. the lccation,
oorkmanship, material, construction and.drainage of the sec -.age disposal syst=em
Serving the above described property, and that it has been 'constructed as sho4n on
L-he approved plan or approved amendment thereto, and in accordance with the standards.
.ules 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
my part of said system constructed by me tahich fails to operate for a period of tc'ro
tears immediately following the date of initial use of the sewage disposal system, or
iny.repairs made by me to such system, except where the failure to operate properly
_ n ��_ r .l t •� mil... i.!1 t
Lti LiiUbLCi •LV clie willful ui, 11e1�11,JE 111 acL c, the Ul \ Lij.uilc Vi �tii uiai�...��� ►+� : y..�. b
The undersigned further agrees to accept as conclusive the determination
►f the Director of the Division of Environmental Health Services of the Putnam County
= ) epartment of. Health ;as to whether or nUt the,,failure:.of the system -_to _ operate was .,
!aused by the' caillful or negligent act of the occupant of the building' utilizirCD the
;ystem< C7'
)at 'd his j day of 19 Signature , .
77�-
�` �i� .%pf•� �. s��f /tr Title 1L.) we-4--
(if corporation, give name and address
-.'; -:._"� e ------------------ .,_ d..'_...�°°:.�_,. --------- ---___
VREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS' BErORE CERTIFICATE
IF COMPLETION' WILL BE ISSUED° .'
UAR NITOR IS RF.OUIPTM TO. FILE NOTICE OF DATE OF TIRST USE OF -SYSTELM.
----------------------------------- ;------------------------------------------------
li.vision of Environmental Health Services, Putnam. County Department of Health
S
Water Supply Publ,c;:Supply. From
Private !supply '-to be d lied by.-
::, t Address uT UM
'Other Requirements / p�
;i, represent that l ^am wholly and-compleite-ly resporiMble.
"above described will be.constructetl a-s shown oh'. the app
Countyc ;.'Department':of._Health .'and that on completi
be submitted to :the.`Oepartment; and, a 'written :_gu` ft*
place in good operating condition any ;part of said w e
ante of the approval; of. the Certificate ,of ,Construe 2
wiI l be ;located as -shown on the approved'.planand that id;_
County'Department of. Health ,
i 97L
a Address �i b
- AP.PROVED,FOR 'CONSTRUCTION , Tl Ii approval expires i
` `revocable for cause, or'_•inay be amended or modified when cor
requires, a -new .permit. Approved'for disposal.:of domestic
'Date
h
the proposed system(s), 1) that the separate sewage disposal system
ie accordance•,with the.standards, rules an , regu a ons o e u nam
ruction Compliance "' saf�sfactory<to. the. Commissioner of Healthwill '
he'- , -,his successors, .heirs or assigns by th'e; builder`, that said builder will
uri period of two (2)'years lmmediately''•following thedate of the issu- I
rig' ;al` stem or any repairs- thereto; 2)tthat the drilled well described above
in• ante wifw.the sta Ards, rules and regua�ons of the. Putnam i
l ".'
P.E.
License No: '
ie d te;rssu unless construction of ,the building has• been..undertaken and"Is
__
Y . by• the Commissioner of Health, Any 'change or alteration of construction
e and /or private water supply only
Tide' f,— /',
a PUTNAM COUNTY DEPARTMENT: OF HEALTH
Division of Enviroifinenta/ Health Services,. Carmel ,N Y. rt 10512
`DISPOSAL
;CONSTRUCTION PERMIT FOR SEWAGE SYSTEM �u ��?AN�'-
�--Wy
r ,r (1"" Town or : V it l$
r
`ilbedte`3i':dt t::a~nt.�e•�L?•�'er� .V
a. �zau -^�- �
43 U4.
LA F ee:e;s�LL
�cf _y�ry
J�CT /OI✓ ` �t'i� �.r1
Loo 7
Job
:'subtlivlsion .
�l �,�. EO'`
' , '
�, +.±� y
A:v 1gl irre cA,MS
Owner•��
sBuild,ng "Type
j address
4
Lot Area �
?
'0'l� Feet
Number .of� Bedrooms%
"Sewerage
`� Total Habitable Space a Square'
feet'X 'width trench
Separate r5ystem to cotl5ist of''
.Gal Septic Tank lineal
To' be constructed by. -
Z.
--- --.
,
S
Water Supply Publ,c;:Supply. From
Private !supply '-to be d lied by.-
::, t Address uT UM
'Other Requirements / p�
;i, represent that l ^am wholly and-compleite-ly resporiMble.
"above described will be.constructetl a-s shown oh'. the app
Countyc ;.'Department':of._Health .'and that on completi
be submitted to :the.`Oepartment; and, a 'written :_gu` ft*
place in good operating condition any ;part of said w e
ante of the approval; of. the Certificate ,of ,Construe 2
wiI l be ;located as -shown on the approved'.planand that id;_
County'Department of. Health ,
i 97L
a Address �i b
- AP.PROVED,FOR 'CONSTRUCTION , Tl Ii approval expires i
` `revocable for cause, or'_•inay be amended or modified when cor
requires, a -new .permit. Approved'for disposal.:of domestic
'Date
h
the proposed system(s), 1) that the separate sewage disposal system
ie accordance•,with the.standards, rules an , regu a ons o e u nam
ruction Compliance "' saf�sfactory<to. the. Commissioner of Healthwill '
he'- , -,his successors, .heirs or assigns by th'e; builder`, that said builder will
uri period of two (2)'years lmmediately''•following thedate of the issu- I
rig' ;al` stem or any repairs- thereto; 2)tthat the drilled well described above
in• ante wifw.the sta Ards, rules and regua�ons of the. Putnam i
l ".'
P.E.
License No: '
ie d te;rssu unless construction of ,the building has• been..undertaken and"Is
__
Y . by• the Commissioner of Health, Any 'change or alteration of construction
e and /or private water supply only
Tide' f,— /',
! PUTNAM COUNTY DEPARTMENT OF HEALTH
HK T _... FT .. l'I� h-LT-
V1yi�,.i�iylAL".
Re: Property of
Date
Loc ed. at ZAm e vY„Yr� ✓��� %G�' F
Block Lot_
Gentlemen:
STANLEY Da. WDER
This letter is to authorize
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
T " .�.1. F Tt. -... 1 t �,., d .L- .. '• l 1- .� .. r. ear r. r.'i— O� r n min mtr �� 1 i
LG�1CL1 1�111G11lr V 1 11GCL1 V h, anu V V g lgll a1 L 11G V Ci J JO l ,y ps pV _ J an ,j j b cna11 . L T'i
connection with this matter and to supervise..the construction of said.
s, stem.. or s- stems . i -n conformist with the rov3,81ons -. of Article. .145,--or
1475 Education Law, the Public'Health Law, and the Putnam County Sani
tart' Code
-4 7�/ .
Count signed :
P.E., ., # 27
STANLEY' I. SANDER
Very truly yours,
Signed_ /KO.7�
'I Owner of Property
� �'V
Address
2
7 S
.245-2645
Telephone
a
HERS.H & HERSH, P. C.
a•.. ATTORNEYS AND.- COUNSELLORS AT LAW __..._._..
.�_.�..7 °J::;r.�... _ .- .u'.'•w- :�a:�r.:cs ".. .:..r.^":.. -.. _,o. v .. n.',.._�:. ":�.' :- ..- .i::..:_�.:..�: :...�: •v, -. - .:.«;e� ::7ti.:r.:c•� ::,:� ..._. _. .� •::i:r'.:..a «.
PARK CIRCLE BUILDING
2 SOUTH DIVISION STREET
PEEKSKILL. NEW YORK 10566
19141 737.0270
BENJAMIN B. HERSH
ERIC H. HERSH
I
August 7, 1984
County of Putnam
Health Department
Gleneida Avenue
Carmel, New York 10512
re: Fodelmesi with Wyatt
Gentlemen:
ROBERT HERSH
Please be advised that this office represented Mr. & Mrs. Fodelmesi formerly
of 254 Tanglewylde Road, Lake Peekskill, New York in conjunction with the
sale of property located at that address to Mr. & Mrs. Bradley Wyatt.
The closing took place on June 28, 1984. An escrow situation arose as a
result of questions.regarding the installation of a septic tank to the
premises, which the Fodelmesi's complied with and received a Certificate
of Occupancy from the Town of Putnam Valley Building, Zoning and Sanitary
Department (Marvin Odell). On July 3, 1984, a Building Permit was issued by
Mr. Odell and was followed up with a July 7, 1984 Certificate of Occupancy.
The purchasers have now requested that we get clearance from the County Health
Department. We would appreciate your seeing that an inspector is sent.
directly to the premises at your earliest convenience so that we may have an
inspection —and :a repor h ereof - e premises as I indicate are located at
254-.Tanglewylde'Road,'Lake Peekskill, New York, and are also known for
identification purposes on the Tax Map of the Town of Putnam Valley as
�TMJ8 1 =4 The money held in escrow is very desperately needed by the
Fodelmesis' to close on their new home and.we/ oou d,[appreciate your prompt
response to this matter. / /
EH :AS
Very t
HERSH
ERIC H. HERSH
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH* S2RVIC'- s, ._ '.
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. /'J
Owner F� �►'J /C.G,EO Address 7.1 I#e A 4C-Y 4er 6t/ /r-
Located at ( Street 4ndicate RW LC-GJY'L� 2D Sec. 460 Block O2, Lot o:5 f 04—
nearest cross street)
Municipality '?U -rtJAjA q&LLeJ . Watershed ?&&K51eIL - "obj _tBP-DoE.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to a er Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
ZZ- 8 job - - 73
3 73
4
3 %
4
5
2
3
4
Notes: 1) TeAts to be repeated at same depth until approximatelyy equal soil
rates are obtained at each percolation test hole. All data to be submitted
for, �':'2) Depth measurements to be made from top of hole.
i
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
_ T T P, F Is 0 1
DEPTH HOLE NO.- HOLE NO. 11� HOLE NO. D C-P ICE:,
G.L. ��
611 1/ t'' / Qp d d�
12" 5AA,1d-`%�4egr of di y ,".57ayE 'dr9.uy /,c�/!c°to�l�,g��nr€ �TD�✓��i9M0 %�ACF �d,9y smw 57,omc- .
W. fi r+ �+
18
24" " di if
I
3011 `,
3611 if
42"
48 If
x
54 � 5 3.;_i 7,r i.l� irLa.f flci �DG'C-
1
66"
72 c fa
811
7-`� - -..
84" if
INDICATE- LEVEL AT- WFIICH GROUIV'D WATER -IS-: ENCOUNTERED : " = -:
INDICATE LEVEL TO WHCCH WATER LEVEL RISES AFTER BEING ENCOUNTERED^ .,..
.TESTS MADE BY Date
Soil Rate Used /O : Min,/1 "Drop:
No. of Bedrooms 2- Septica
Absorption Area Pr— oTd Bye
Addres
THIS SPACE FOR USE BY HEAINH
Soil Rate Approved
DD�1G1V T., D f
S.D. Psable Area Provided
nk Capacity, - Ca Type /yS.PWR -
L.F.x24" [1 width trenc
OMPM
05
Nt
0 P§_7
-K8 4'.
d,
0.
me before tww
TbB jqm':
ol
mi� oil
lawf d.
do
gee
4
eeeov, /U
4n OW17 `�S 21�4.s &
.145
No. 3%
7�
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