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631- 589 -8100
84.14 -1 -16
BOX 34
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9 94.1
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inz Ge
or, building'
Heinz Gaver..Ince 119
:...,WWU4jn9 -Conatruote do ah
2
Qwwraberm bit-am U0.11, 4AP
t ros 1,
2---story colonial 10, Geyeroberg
Typo Lot
wrlding
GUARANTY OF SEPARATE SEWAGE- SYSTEM
I repreaent that I' ax wholly and. completely responsible
respon sible for tthey joc4t Ion, workmanohip, material,. construction and drainage o f the sewage
system serving
the ab i an
described property,' - d that I.t has bean
ove
constructed as shown on the approved plan or approved amendment thereto,
and, nd iA accordance with the. standards,' rules and regulations of the Putnam
County Do &114 h6.reby*guaranty to the owner, his succoo-
partment-o f Health,
assigns, to n any part of
pol heirs pj�ce, J4. good operating conditio a
or asslig
said system constructed by me vihich fails to operate for -a period of two
_7ears immediately following ..the date.�of initial use of 'the sewage disposal
system, any repairs - made, by me to -suck, sYste M., except where the failure'
to operate properly is caused by the *willru , 1 or negligent. act of. this ocell-
pgnt of the building utilizing the system.
The undersigned further agrees to accept as. conclusive: the de,
:termir, t f. of* the Division: of Environmental, Health.. ser�
Ion p t.h Director - ':-
the
inI4 -D,e in
P� -a t Z. -o L ZYE Ro"
41-083, r part. erit
fAil.ure of the lsystem to operate.wao caused by the willful or negligent
.(;up utilizing building u Itzing the syst
Apt. of the o.c., ant of the
Da t a day Of 0" nature
akax -T
thA q 4th
e
All, Tit lexkum2m President
ho giVo name
(if : corporAtiox
Building 'Con 0
.9 and address
Date 9/10/77 Heinz* Geyer
- - - - - - - - - - hovers : hane, 4kanam Vajley gN.Y.
THHE9 (3) COPIES ARE REQUIRED WITH THREE (3). COPIES OF FINAL FbANP AMME
t PI
CERTIFICATE OF COMPLETION MILL DE ISSUED.
?:,0VARANTOR, IS REQUIRED TO FILVATICE OF DATE OF FIRST USE OF SYSTEMI
piv!004. of 41 al Health Services, Putparq County Department or g@al#x
tient Ndme / �!�
Pa
Roselake Medical Laboratory r
- u
Old Stone Bldg; 21 Clark P,lece: Addressor= -
Mahopac. N Y 10541
W n
�:,a � -�: :gar: t, �:,.� •_ .. . _ „� T.o ,.a_ '� - 7 '�br- 3��a°+�- ^'�°�•"•- 5ye -...� ...s.+.n31... w... . �,�r'. :
(71 MISCELLANEOUS,. Acgessioo #
.. TEST REQUEST e .SPECIMEN— SOURCQ
C.
DATE ooNe TaCMNICIAN
ml
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING.= CARMEL, NEW YORK
;.. j we�3cirt. is't;; -b turrp eci y: �. it ;;:a14E: and sabnitted tc- County-Hea th D-apartmeni ogether With i"oratory report of - r
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
OWNER
NAM f
ADDRESS �®
LOCATION
OF WELL
/(No. IrStra.0 (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
DRILLING
EQUIPMENT
El ROTARY ®A COMPRESSED CABLE R PERCUSSION ❑ P RCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH (';at)
�)
DIAMETER (inches)
WEoUHT PER FOOT
®THREADED WELDED
E OE
YES ❑ NO
I G ?
9YES NO
YIEL
TEST
HOURS G.P.M.
❑BAILED ❑ PUMPED COMPRESSED AIR 74 7
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Speclly feet)
DURING YIELD TEST fleet)
Depth of Completed Well OO
in feet below Land surface:
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches) FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
... -. ... .... ,. .�. �. •. srT�`•. -. \+f —, �... ... �,.+. r.. _.. -� n
(/o /
, JKV—�
s. ... ......v
..tom .a- I.r
... _ \y'_r.... ... e.,, a ..- ... -�.. w+ rsrr r.-
T-7
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WErZA, PILE ED
1
DATE OF REPORT
W R gat )
AS 6UIL PLAN
NOTE -il JS J5 ('O CEP TI V)' Tk;,4 7 5 1: A 6r J13 I-
3 YF -EAl 'PUCTCI,�' A,5
7 WA -i C ON57, ON :T N?, -A
AND r,14AT T14E SYSTt';Nl WAS INSPECTED 5Y AI C Far r
WAS COVLPLD OVEP- THF- 5YSTEAj PIM5 C0JV5TA,,i.
IN ACC09DANCE W11-14 ALL T-",E AIULE5 AND REGULA O/Y_5
OF Tfif-. PUrIVAM COUNTY 0/-- iiP.-A
E-XCEpT1()1V5 70 7-"E- A8L)VE, if- -'ANY NOrL.L) BELOW.
TY)
AS 8UILT PLAIV
OFSiCK'AGE DISPOSAL SYirCM
TIE Af EAS U M
RCENrS
GA ri o tv
4-6
47
OF PUTIVAM 'Y -1
I'
9
OC I
C,
Z-
DIVISIO14 U
so"
'j
PUTNAM. COUNTY -DEPARTMENT OF HEALTH
Division of Environmental Health' Services, :Ca rmel, N. -Y. 10512
CONSTRUCTION "PERMIT FOR'SEWAGE DispasAL SYSTEM Town- of, Putnam�Valley
Town or Viage.
La apprgx, 800 -f t
ll
S,out - herly side Cindy s, -Lane
Subdivision Geyersberg Lot to Job 1072-5Pe
Owner 'Heinz Geyer, -Ind R D. 1 7 Lovers Lahe.,
Address
Building Type _2 s t y dwe 1. 1 ing. Lot Area 44,017 sq. ft. Putnam Valley., No Y. 10579 7.
Number of Bedrooms 4 Design' Flow 11-15.-minutes Total Habitable Space 2375
—Square Feet
e Sewerage System to consist of 1 500 1-.- f. 2LL- inch trench
Separait' 200 Gal. Septic Tank and
To be constructed by William Albert. Address Route,6.0 Mahopaci W* Yo
Box
Water Supply: — Public Supply From
X Private Supply to be drilled by Anderson Well Drilling.,,
Address -Barger Street, Putnam valleys NY
Other Pequirement
Install curtain drain and swale as shown. on plan..: Comply with a
q
requirements as outlined.on sulVilvision pt4t and trite6rated plmi
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 t6 and in accordance with the standards, rules and r egg lations,77 Fe—PUT—nam
County Department of Health, and-that on completion thereof,a-"Ce rtificate' , o f"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 bu ilder, I 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 appioved'plan and*that said well will be installed in accordance with the standards, rules and reg-u-100—ns-of the Putnam
County Department of Health.
Date June 22, 1977 .1 d
k P.E. PE— R.A.
.burg s$
P T) Hor'sopouna Road, 1, N. X. 19�V 9845
Address Carmel, Ile No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued . construction t, . of the building has been undertaken and is
d
r f
revocable i6r cause or may be amended or modified when considered necessary 'by the Co mission h. Any change or Iteration Lfconstruction
r
requires a new permit. Approved for disposal of domestic ar s age, and /or 'i to W t supply only.
tu
Date— By Title
M3
e4
PUTNAM COUNTY i.
Wal al_�r��;;�
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. .10512
DESIGN TATA SMM-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 1072-582
o R D 1- Lovers .Lane., PutnaffiValley,-:NY
', i ., Heinz Geyer Inc. Address
Cindyts
Lane
Sec. 119 Block 2
Lot 10
Micate
nearest cross street
Town of .Putnam
Municipality.
Valley
New York
Watershed
City
A SOIL PERCOLATION TEST DATA REQUIRED To BE SUBMITTED WITH APPLICATIONS
Role
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth
to water Water
ve i
No. Time
From
Ground Surface in Inches Soil Rate
Start-St6p Min.
Start
Stop Drop in
Min./in drop
Inches
Inches Inches
1 10.10 10:21 11
24
25 .1
11 Minutes
210.- 23 -34 10. 11
.24
25 1.
10:35 1-0'.45 10
24-
25 1
10
4
1 10:15 10:25 10
24
25 1
10
2 10:27 10:48 21 2l. 25
3 10:50 11:01 11 24 25 1 11
4
2
3
4,
5.
Notes: 1)' Tests to,be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole; A data to e submitted
for review.
2Depth measurements to be made from top of hole.
i ►�T�+ T L1R T��
..... ..Ci�'. .sC' -'• -,.a W,- hd- 7fdra.T:t4dClmi-A'- .rtiiL'aLi;T }a�:l:f:Ei ,.a.`J11A" 111„ 1/ t�•.¢ �L�rl'vlals'L`91'YmlVi°,- a- c'i;T. -.... ... "-r'.*
i
9
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO. 1 HOLE NO.- 2 HOLE NO.
G. L.
6"
Loose sandy loam .Loose sandy loam
1211
" rr
r
18"
11 it
24"
,1
„
30t1
3611
n Ir
I
4211
if - if
4811
Sandy Loam with clay and small stones
-
11
_
54 11
rr
i
IT
6011
"
6611
IT
7211
811
11 "
INDICATE
LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS Burgess & Be P. C. 7/15/74,•7/19/74
MADE
BY , Date
Soil Rate
DESIGN
Used 11- 15Min/i "Drop: S.D. Usable Area Provided 5, 000 SF+
No. of Bedrooms
4 Septa Tank Capacity 1200 Gal Precast cone.
O °FW
Absorption Area Provided By L. F. x24 �� t � end .
,the
.Name Roy a. burgess brgnature �
._ t
Burgess & Behr P. C. '=
},•
Address � ' SEAL a
Forsepoun Road
Carmel, tis < 4.9 ��•
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal.
Checked by
Date
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
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code'.
Very truly, o sf
Signed G'
ei'e�re° c.
Countersigned:. 9845 bane
AA dregs
P.E., R.A., # Put$a valley9 N. Y..
LAA �4
Burgess & Be hr. P. , C . Telephone
Address D 8 - Horsepound Road of :�
Carmel, N. Y. 10512 s����
� �5 ®3312
Telephone
y "� v.-„ r-�.
x .n,'!+. ;m%v a�.,,,� . ra. :�";.- ":�e•'S.� �47�,_�� V' vr. s ....r .c + �¢�T>
. - -«wn. 7e _ '� Wr�^4�-a- .�'C r.^'.: s.._ l - •o-
t-.. "CAM^- r..•;nac'� =' �4+ cn
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_.
'June' 14s 1977' .... ...
Date
Re:
Property of Heinz Geyer,
Inc.
Located at Southerly
l s ide Cindy l s Lane
�.
° U.' lvisloT o
Section 119 Block Lot 10`
-Gentlemen:
This
letter is to authorize ? Roy A. Burgess
X
a duly licensed
professional engineer or registered architect
(Indicate)
to apply for a
Construction Permit for a separate sewage system; to
`I
serve the above
noted property in accordance with the standards, rules
or regulations
as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code'.
Very truly, o sf
Signed G'
ei'e�re° c.
Countersigned:. 9845 bane
AA dregs
P.E., R.A., # Put$a valley9 N. Y..
LAA �4
Burgess & Be hr. P. , C . Telephone
Address D 8 - Horsepound Road of :�
Carmel, N. Y. 10512 s����
� �5 ®3312
Telephone