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04437
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04437
PUTNAM COUNTY ADEPARTMENT OF HEALTH
Dwision of «Environmental' plea /th Serwces Carme/ %V Y f05i2
a
CERTIF1CATE OF CONSTRUCTIONnc6mPLIANCE FOR SEWAGE D100SAL- Putnam_Valley
SOLI �3 id6 P6' gKl l mss! –IOW . Y ii -- --- 1 -r-- Town or village
more or less from Cin_dyt s Lane 119 2 ag
Located Block
at: Tax Map
Heinz ever; nc. 1072= r -�
Owner Lot . b 7
,- x' I
Heinz geOYP- , nc . R D 1 Loeers �ane , a= . ey.
Separate Sewerage system bwit by ddr ss
1. f. 2 inch renc
. Consistingrof 900 Gal Septic Tan and` 375 — t
Contractor£ has reversed curtain drain to drain east ra er
.. nt (� _ r
than a9 S rintb ri eg ,
Water Supply Public Supply From O e oII the ie s o he easi
alanchuk 1
`R Private Supply Dnlletl BY
Address
} 1 sty frame
•
Budding Type ; _ No of Bedrooms Date Permit Issued $
n0 ± "&
-Has Er, osion Control Been Completed+
1 cert'! that s)'Ss Listed serving the above premises:were constructed'sessentially as shown on fhe plans
the.system( _of ttie completeq workf(eopies,of "wh�eh are
attached) ;and m accordance wdh the standards rulei and regulations, plans "filed and'the permit issued wby ahe Putnam County Departmentiof Health
i N i
Ju7. 17, 1978
Date �
„ AtltlressR <8 Horseound' Road, Carmel:, oY.
F
Ucen No 7
,
A Y r (! . y , ..y to secure the correction, of any "unsanitary
ny person occupying premises servetl b the above systems shall prom tl take such action as ma be;necessar
9 Y
conditions 'resulting from, °such `usage approval of the separate, sew ers e?s stem shall become null :and void;as soon gas a public sanitary sewer; becomes
avaU able ''and the approval of the.<private water = supply shall become.n I a ' -void when a =putilic -water .supply becomes avallable -Such approvals'.'are
subject to= modification orjhange whe ih the judgment 'of the Co mis r Hea h re4ocation,, �f� cation or change Is neeessbry.
Date Trtle' =
.:_ .• �. '. ,: -. � �.. .. •� -n• .�_ = -�{ _.a. _�' _. _ __... -__ Y.. .. ... __ ��.-. --WAS_ .-._ �'Z., _.�_ _..+.. �__....
Roselake Medical Laboratory
Old Stone Bldg. 21 Clark Place
10.5-41
(914) 628-3280
Patient Name cv Age
Address
to' D V
Physician
MISCELLANEOUS
MST REOURSTED
SpEcimn—S."Ce
OAT DON TEMNICIAN
4,-,Y,N�
TOW1T OF. PUTNAM VALLEY.--
WL11L DRILMRS LOG AND RE20RT
I
WELL DOCATION c? 2—
'street section block lot
�i�
WELL OWNER _371a4e e.? U,_.
name address city or town
R
WELL DRILLER_ All Af Va
name address city or town:
-CASING DETAILS
YIELD TEST
WATER LEVEL,
SCR M DETAILS
Bailed
(Measure From 1,
and surface
tengh: feet
or
Pumped_?Hrs.
Statit,. —ft.
Make:
When Bailed
1, ot
lot
13f
'tameter: Inches
Yield.: GPM
or Pumped ft
Length -Ft.
size
Kind:
Diameter.. 'In.,
)'AZ; DEPTH- OF WELL
Feet
Depth From
'Give description of formation penetrated, such as: peat,
Ground Surface
'silt, sand, gravel, clays.hArdpan., shale, sandstone,
ranite, etc. Include size of gravel(diameter and sand
fine, medium, course), color of material, structure'
(Loosel packed, cemented, soft, hard). (Ex.' Oft. to ft.
.27
ye
Formation
eej%J-' o Feet
Description Sketch exact location of.well to
at .least two permenant Landmarks
Date We!! Completed. Date of Report_�/;)z
Well Driller,/
4signature
4 '
�` yF r .. aw, .t r,.�c .: r•`. -•��t ;.-:.a _� .r.� -._ :: .. p. �.....: R=, �'?' ".:P.:`'�'�— -- r w: .i..3 .=c ' =,rs r.�-�..�;- .�- _..... ._ .— .
17Z&l A,
Owner or FurcLiaser o aui i g
'Building Construct4d by6.
lap
Location - Street
Building Type
La //f
Municipality
ect on
Mock
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 succes-
sors, 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 made 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.
q The undersigned further agrees to. accept *as conclusive the de-
termination` of .the Director -of , the Division of Environmental .Health. Ser-
__. vitas ofthe._PitYaam:.Doty 'Depa „tment .of :Health as. to whether. -.or - not the
failure of the system'-to ope:rat.e was caused by the willful*or•negligent
act of the occupant•of the building utilizing the system..
j"
'Dated this ! day of \/ 4 l 19® �� r Signature �
✓�f c,�C4JC -� C.% /Gr C, Title / - > �,ti~ �r r
ZIT corporat pf' give name
.r
�2- _ and address)
THREE •(3) COPIES. ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPtETION WILL BE ISSUED_.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
— - - - - — — — - - - — — — — — o — — — - — - - - — — - — — — — — — — —
Division of Environmental Health Services, Putnam County Department of Healt-
- - - ` n `.Y' i4
h F= .pi T". `PLAIN + ` N TE : THIS /5 TO CERTIFY TLJAT THE SEWAD6 fOSAL
s AAcV SYSTEM WAS CONSTRUCTED AS INDICATED ON TN/S';PLAN
•� r AND THAT THE SYSTEM WAS INSPECTEO BY.ME BEFORE /T
d.,
WAS COVERED OVER_ THE SYSTEM WAS CONSTRLCTED
4- LOT3
¢ IN ACCORDANCE WITH 'ALL THE RULES AND REGUL4`TI01VS
llot�°� 1; _ OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH,'
ff �• t .
FxIST�NC,
DwCy EXCEPTIONS TO THE ABOVEIFANY NOTED 6ELOW.
-GL f ? AT w T ED ? L,FA! N E LQ M 4U,` 1vI•5 Ir NUAn/At'Cri N r. ROS�$
'TG T� N
T roI. 7 l HE c4 G T! - f-,,4 E A R CA T
71 / } s t'•f��- I i 6i S 9 _ ...`,i L <:1,,?7A /N D�C's1:;N .r0 O /t' / =):'n/ fA.`.,,r
Q 3 �' ^'•'� .1,V/) G/r ANc y. ^-�+/D Tti'f' t'i =�D.s rfi 7'�IF EAT,
7 I r� 'Ni5 A, RA:�?C�, �.,,: "!✓J ,`.' EV15 �#T:S Ac T.,Sy A '4) Eh..
c� _ SQL i
'`• sue, %`
AS 8U /LT T. PLA/V
OF SEWAGE DISPOSAL SYSTEM
TIE - •ASURE ENr.S
A 60 C T /:O/V c
/ +.• �'— �2 M
Tow- � /�urkJ ,n VALLff s PUTNAM CDUNTY,N.Y.
IkPPRCrVE
8•,_ � G: • £i_ !_7 # 1. $ �4"45W�Q>`�CCi
y) ..s•I'Wl ✓LX R• `/
1 }�,s t�` 4•. jUL21197
b - �Rv :' t d »� -- 71iIM •1{
Vt. OF - HUM
BURGESS e EMR, P. IV
ry _ "�T PAL
�' � '" a Piofessiono/ En9,nee�;n9 L4nd Sum ✓ey /7-9
- -_�
128 G /enelo'a Avenge
2
ii
.�
PUTNAM COUNTYr DEPARTMENT OF HEALTH
T ;
I. Qivisfon .of Environmental Health Services ..Carmel N. Y. x10512
CONSTRUCTION_PERMIT- FOR SEWAGE, DISPOSAL SYSTEM;,
t Puthav! Vall®.y°
Sout,heriy side Peekskill Hollow oa X00 ft�9 Town °r village 2
Li lid - ion aio
Subdwlsion Lot - Job
He nz ey r, Inc . R D ra r` s 1 '.I o Lane
Owner = Address
buildingTYPe 1 "� sty frame 'dwel 1, 5 =9q ft, Putnam .Va11 y, 'N. '
9 e 10 79
F _
Number of Bedrooms Tota itabvle Space E 1
Qoo _ _ n . 44uare Feet
7 Gal Septic Tank' (meal feet X G lnC
Separate- S'ewerage? System, to consist of t
Heinz Geyer, :Inc.; Lovers Lane
To be constructed° by Address
- Putnam. �1'a11�ey, .�N.
Water Supply Public Supply zFrom d -
Prvvate Su I to be drilled b ;
x Maiam'c uk
PP Y Y _ _
Croton a s,
All restrict��f'�SSs
-other Requirements O r'O�eCt _field &1'ea. 1 ft cut and fell needed
- to insure: maxim urn grade of
7 represent that'l am wholly anti completelylresponsible for the design and location of proposed, "Sy Site m ( s);u 1)rt that the* separate sewage disposal`system
above described will be constructed as shown.on the approved amentlinent thereto and._'in accordance with the standards ,rules and regutations'o "the Putnam
County Qepartment of Health,' and that on completion tfiereof a 'Certificate_ of niir6`cfii Compliance `seti; factory to th`e Commissioner of: Hea)tAwill
,be;submitted to;the ^Department -arid a; >;wntten 66a ira n tie!-,w i i r be`furnished'the, owner his successors heirs;6r assigns:by thebuiider; that saiq:6uilder -will --
place in :good operating ;`condition. any part of said sewage disposal sysieiii during the period of: two (2) ygarslimmeii�atelyRfollow,ing, ?the date of 'the issu-
ance ,of the- approval ,of ` the Certificate of Constrpction -Compliance of -the, original system or any.repai"'-t rhereto 2-) ?.that the drilled �well'deidibed above
h
will be located asshowmon.the approvetl' plan andafiat said well will, be msti lied n": accordance' _with the" standards rules, and regulations of . ;the Putnam
County Departrrient of Health r
November 1.1�, 1977;:
Date fl x ede
f 83 �c Be, _
- s . el 105 12
A Lcen `
se No, 9845
.N• .ddre ound 'Rd. .Cr
_. -
T' APPROVED FO R'CONSTRUCTIOIV This ,approval expire ;tone year from the date issued unless•. construction of the budding' has been uriderfakeri and is
revocable for >`cause•or.inay:be amended or modrfied: when co, 'aere- necessary by Elie, or of Health. Any_change,tor alteration "ofjconstruct•ion°
requires a- new per %mist[ A.pprovedffor tl sposal,of domestic, n r,- se age,' d /or r., wale su p p kV oniv z {
tle
Date
1
i
y
COUNTY DEPARTMENT OF HEALTH
Ootober 31,, • 1977•
Date
Re: Property of
Heinz yer, Inc.
Located at
3
Section t Block Z Lot !
i
-Gentlemen: Lot, 3 Geyersb rg
This letter is to authorize l,
Roy A. Burgess
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 promulagated by the Commissioner of the Putnam County
Department of.Health and to sig n 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
__..._q_�...,,,.... -„ :•,•• - •,1- 7;. Education-- F:aa� t:��� �abA:e � eal:t -La:;i �a�i e:, am- ..oun±y •�ana;;..R.. ,!._. ' :' __
j 'tary Code:
Very I /1V, ,
Signed
i He 1 rm nVro Wr WWO.Oty
Countersigned: er8 Lane
9845 Address
P.E., R.A :, # '.Putnam Valley9 N. Y-,10579 I
Burgess &Behr, P C ,'- G Telephone i
Addre s
R D ° Horsepound Road
Carmel, N.Y. 10512
f;
!
225-3312 VON
i:.4 :
5 °33 , p
• ,;,
Telephone
pR0 SUR
F VEYOR
ESS10(4
PUT-NAN DEPARTMENT.-OF
77 7777- .
,,77,rx� r - 'ys':7.:•`
i.
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SIMIT- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 1072-594
Heinz Geyer, Inc. R D 1- Lovers Lane Putnam Valley., Owrl��t , Address � ys
Located at ( outl� 1� s�de n'""s"ill Siio11��9
tree oa ec . Block 2 Lot 3 '
n ca e a cross s ree,
of 3 Geyeraberg
Municipality Putnam Valley Watershed N. Y. City
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Y Number
r
CLOCK
TIME
-
PERCOLATION
PERCOLATION
'un
No.
Start -Stop
Elapse
Time
Min.
From Ground Surface
Start Stop
Inches Inches
ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
13:16
3 :28
12
24
25
1
12 Min.
23:28
3:40
12
24
25
1
12 "
33:40
3:52
12
24.
25
1
12
13 :17
3:29
12
24
25
1
12 "
- 2 3:29
3 :41
12
24
25
1
12
3 3 :42
3:54
12
'.24
25
1
12
4
5
1
2
3
5
Notes: 1)' Tests to be repeated at same depth until approximately 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.
•a
,o
. G!. ' 4s ( ,'Sit'Y , f -' 6,' - nye.. -'M <a� 4'r,.Z'.' . v' s c ^9�� ... -4r = .^.�,ti w.'. b [1"^, . i'!ti. yy.. r' c ,�t.• i , t' M.-. .fiS°`. - Es dFr � . r�. � � . •r ,�¢a .- : - _ r..
!i TEST PIT DATA REQUIRED 'TO BE SUBMITTED. WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE N0. 1 .HOLE NO 2 HOLE NO.
G.L. Topsoil Topsoil
G'r
12 ".
18n
24t1
3 Ott
3 611
4211
48"
5 4rr
6 Ott
66't
7211
_ .7$77.,.
36", dry sandy loam, (loose)aaaa0aap6
tr tr
9r Ir
Sandy loam with clay (Packed)a.aaaa
it ri
Ir it
tt
8411 _ It ��rr
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH.WATER LEVEL RISES AFTER BEING ENCOUNTE D
TESTS MADE BY Burgess & Behr, Pa Ca Date 7/15/74
DESIGN
Soil Rate Used 12 Min/1" Drop: S.D. Usable Area Provided 5000 SF +-
No. of Bedrooms 3 Septic Tank Capacity 900 Gals. Type Precast : cone.
Absorption Area Provided By 375 L.F.x24" X 36tt w Eiii Other
Install c=urtain drain to. protect .fielTarea s�� yo', .
Name Roy Aa Burgess Signature BU��
Address Burgess & Behr, P& C. SEAL
R D - Horsepound Road• :..'.,
Carmel, a a LU5 12 y 4�
PUTNAM COUNTY DEPARTMENT OF HEALTH
Soil Rate Approved _Sq..Ft. /Gal. Checked. by Date