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84.14 -1 -18
BOX 34
04445
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04445
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k' Y641K IkFt a f �y.
Building
UWoxi'or P14rchAiset, or WURICIPAlity
119
2
81- Geyersberg
bo t
GUARANTY OF SEPARATE SEWAGE SYSTEM
I r-opre-sent that I am wholly and completely resppno
for the
7,oc►t14no wqrkmanship, material drainage of the sewage
conatructipp and dra,
dispoaal system serving the above described property,' and that I.t hap been
.constructed as shown on tho Approved plan or approved oved amen
dment thereto,
.;ancl in accordance with the st4ndar4s, rules and regulationo-of.tho Putnam
County Department of Health .and hereby guaranty to the owner, - his
sorp, heirs or'* assigns to place, in good operating condition any part of
said 4y.5tpm.cqnjtructed by me which rails to operate for a period
of two
..,year4 immediately following the date of initial use of the sewage,dispoagj
system* or any repairs—inade by me to such system, except where the failure
toopprate properly Is caused by the willful or negligent. act of the ocau"
pght of the building utilizing the*.gyatem. A
The undersigned further agrees to accept as concliasive.the do,
..tormlqatlon of the Director of the Division of &jVj
.1rQnmenral Health $erm.
-h'- -O'th
J, 0
-'nab- -the '",
failure Of the system to operate was oa4ead by the willful or negligent
act of the qqqu ant of the building utiltzlng the 4yete
25th day of AUVet 3.97?
Dqtq4 this
Signature
8
Title President
- B qlmtr (If
corporation, givo name
Date and address)
ftinz Geyer, Lovers Lane
THRE9 -(3) COMS ARE RE(4UI
RED WITH THREE COPIES OF FINA PLANSFFRE
CERTIFICATE QF QQMPLE.TION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE QTICF, OF DATE
OF' FIRST USE OF SYSTEMq?
4VI4104 of Environmental Health $qVvIqea' Put;1414 County. Department or P04101
J914) 562-0890,
EnvrorT�est' ® 234.BROADWAY.
NEWBURGH, NEW YORK 12550
Lab`:oral=airie.s
,SACTERIOLOGrcAL EXAMINATION OF WATER
r,'EG,::�oo'�iS°C r'�tJ^. ``•?,,y�!$t �bi'�Li!"rf - �'±= `'%a�+;;>.�' 7s:.�i.i.�r �Lt.Y nC,, """ET: +:
Lab No.- N- Lab-No. Ent % Time Set -
-
Tests.- Requested - J- .• _ ��`� � Refrigerated.`
Coll d. ,bY, 7- v t'~ l /c: ggency Goli d °for -
a
Coll d from; 'Name
P'v lea F
(St., Rd) (City Town, V illage) (Zip Code) (County)
Identrfcation`of Source ", G= (�• -
Sap�rng Point
m
Supply Chlorinated wlen sampled Yes ; No (?�°e Free Comb pH
RESULTS'OF EXAMMATION OF.WATER Standard Plate Count
s 10 1r
MPN�1:00 ml Bacteria per ml
'- `� ` " �• � �. � e Method /100 rnl � °
Coliform Group_ - mbran
Total-Coliform
Fecal Coliform
Fe aal Coliform `
s
These results indicate = s' ample (was, was not),of satisfactory sanitary quality when the sample
„" .: _ .
F"
was collected.
CH ' AICAL .A�VD 'RHYSI_CAL EX'AMIINATlFON OF- WATER
GHEM4C -AI: EXAMINAT(064 (Results`in Milfigrams Per Liter)'
gii monia Free,(.. Nw1 [} Arsenic. ( WAS (Detef9ent0.. .
Barium �
Nitrates (as NI Cadmwm
[] Chromium Q
.- -- -- --
u Ial
[] Sodium . ; ;" �] Iron El
:
Q Stilates i� Lead
Q -, -• .
Fluorides -
` ❑ Manganese , PHYSICAL EXAMINATION
Cfitorides,. TO Q Mercury . n
E] -Hardness, Total (asCaSelenium 31 Selenium [] Color U its
[].T.urbidity Units
_ Alkalinity (asCaCo,Jy�,, []. Silver �'
Odor Units
Zinc,
The chemical parametees tested (were, werer ot) within •` -
the$ - limitations of the Neiw .York State drinking water R ep ortedby DATE REPORTED
standards when the sample was collected The results RONALD A „BAYER LABORATORY DIRECTOR
circledstepresent,those m =excess of the liggations _
�_
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
:,.'°7r:; ^�, - 0��11�- �^• 9yat? �' 6S" ' L' 7. �w7- Z: fSr"' IF' S'.'.. �° e". C' l��G"' if' 7�i' a�` �' e- iFr' �; i8: tir3: Z�uli` D�riii�C1 '�fD +r+�ili���'r'IB�ii�l�-tl' ief!"v'iO�. a�1e'� �ilfl�'li 1'13G`r6�Ol�f
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
ADDRESS
K /ice
LOCATION
OF WELL
(Nora Street)
(Town)
(Lot Number)
PROPOSED
USE OF
WELL
DOMESTIC
11 SUPPLY
BUSINESS
❑ ESTABLISHMENT
El INDUSTRIAL
l
❑ FARM
❑ CONDITIONING
❑ TEST WELL
❑ O(Specify)
DRILLING
EQUIPMENT
1:1 ROTARY
COMPRESSED
)LJ AIR PERCUSSION
❑ CABLE
PERCUSSION
❑ OTHER
(Specify)
CASING
DETAILS
LENGTH ( feet)
��
DIAMETER ( /nchesJ
4 r r
WEIGHT PER FOOT
/ %
THREADED ❑ WELDED
E 5 O
YES ❑ NO
W CASING
LJ YES
NO
_ YIELD
TEST
❑ BAILED
HOURS
❑ PUMPED COMPRESSED AIR
G.P.M.
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC (Speclfy feet)
feet)
DURING YIELD TEST fleet)
of Completed Well
in feet below land surface:
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
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
r
i
,
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WEL C MPPLLET D
DATE OF REPORT
W RILLER 5 nat e)
"
•p _san't''S `- .',°,r >•.�:, :li: T' 1 .i -» _ 't ,1: .TS:o :y -_ 4 " - _ r
r _ L' I
9O CQTlFY:,TtJ 4T T
� �„ �� b'*, "t'"•3:�• rr; � c •r•� �° � NE 'S'E'WAGE �AISl,��SA:L i
:x.. L s. 3 ttiM' }. _.3n'•.8'-r•FE L1. �z i,. SYSTE/vl: YVAS " RUCTED AS IND7G 4TE'D ON Tw. 'PLAN.
'
k x� vi a THAT -TRE SYSTEM WAS 7NSr?ECTED: 8Y. ME :pEF(�qE %7
?' WAS COVERED.OVER_ THE SYSTEM WAS CONSTRUCTED
IN`. ACCORDANCE WITH ALL THE -2ULE5.A1VD'REGULA• i` 1ONS
OF THE PUTNAM COUNTY DEPARTMENT OF f-IEALTI-l_k'
>sE } �• t
f . '{
LJT�, [: x7S 7 r IV G 9 EXCEPTION
$ , TO T14L ABOVE IFANY NOTED 13ELOW.
SIR SYS T EM HA 3 WELL ConlSrRt -t.CT � D.
/W TEGRATEG Cu ,erAYN JR/+:n/�
1 f?OM t ?IGNT ,l tQon r' CORM �,r : s E /'i A) TO
z s ;noT -id+ DRA iN ;r EASE.M €r �Stul._ G'.
�•� , ;�N t - ( F rp.r p
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i/4LLQ7V .SxYALEY_ A/(D ;Okt /'EYED CURTAaN Q»TA /%/..-rim
'j. s� � 3. k,7?4E DR/ v5WAY,. IVONLdCA.iEOIJNTNERIGNT•-N.�n/D -SIDE �FfKTiyE-xy
LrN ` �.I Cl/7 oAF k� ,ArER THAT MiG�yTO�PDiN,4_RiG y cF�ECT.. THE F/E t,aRE�t,.T�E
Q FULL EASEMENT f 7?N.G OR/� /N LbCS.77/E SAME' .0 S /j RC7E
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E oTNF A UR/4INs /rs.o -�a.P. 1/v/CA _
If THAT BASEDDiVTNE A lORE% VIE /VT /0/VED `AGjS� 7�/EGJR�A /N DA'A /nl
MF/vTiONU /N /va! -F 2 /S NOT
AS BlJ1LT LAN
IS8 2Q MAI,iG NANGC '
�° OF SAC WAGE.. D 5005AL SY.3TEM IN
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fLEY4T'•!ONS �i°TcSFAC D?m t cw /�
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' ✓ -��i 7� } M PUTNAM COUNTY - DEPARTMENT OF HEALTH
t 4�3* Ofwsion of .Enwronmenta /4Health' Services Carmel N •Y 10512
CQNSTRUCTION; PERNIIT-�FOR S�WAGE.DISPOSAL $XSTEM ;,' w, . T.o:�an - of..Putnam'wU,alley - °
Sou
the y se in ;� s ane ppro
a t: t �T n or Udge r 3
ow 1LS
•
e7� „i.- $LSd.&Te�'i— ;'�— x��•c.�� .. *,.ifl= 1�'LSTnT+'"�Rd1°(t x <o.,..r4 .r'cn.rp`ol'a X�`�1�aP �+ °4 BIOCk
e
v} 072 575
Subdivision,.
He i nz Geyer. Lovers Lane
Owner Addres -
euiltling Type SpZlt level' Lot Area 1 acre plus Putnam Valley, 10579
Number of °Betlrooms Design Flow T al Habltatye pace �K n Squ r t x
-N - r
J _ t of �ncE tr h N
'.Separate_ Sew re a e,5 stem,�;tot,, consist of +q�� ' c tic
To;.'be constructed by h 1 Std Martin y A r `sr yY
Water Supply Public Supply From
_ . x Ma; a c w
Private Supply to be dulled by
Address Cr:o t on.< F6118' , N . Y '
Other Req'u`irements e 1 n all details Shown on IntEgrated Plan d t 10 2 to; r
1d .
I,represent''that I am' wholly and completely responsible for thedes�gn and location of the proposetl sy'stem(s 1j th f separate sewage . isp 's .system
above described .'will, be constructed ,as shown on the approved. amendment there to and in "accordance with.the stantlard les an�egu a ions o r u nam
County Department, of Health, andathat on,completron thereof a Certificate :of Constructwn,:Compliance saRtisfactoby;to the Comma ;stoner f Healthwill
be, - submitte i to the Department and a written guarantee' will be furnished ,the owner his successors; heirs o►'assigns ti'y the builder that id builder-will
:-
place m good 7operating condition any pact ;of said sewage „ disposal,. system'tlunng the period of two ;(2) years ;immediately followingz;t `edate.of .643 153'67:
ante of 'the- approval of tRe Certificate of Construction CompUanee: of the original. system or any repairs thereto,e2) that the d ►,riled: ell described above
4wiil -'De located as shown on ahe approved plan`and that `said well will bAe; installed =in accordance with the standards rules. 'and re Tula i— o� ns of the Putnam i
County )Department' of Health w T
September 28, 1976 .� `
Date P E R A
ned
urges 8c Be.Y4, 9845
V
Address License No ?
4
APPROVED °FOR GONSTRLCTION: This approval expires one year from the date issued unl constructwn of the.building hiss been undertaken and is
'revocable,;for rouse or may_beamended or;motlified wlien'con'si a net nary by,the;,Com ssio r, ,of'HeaIt > Any change'or, alteration of construction
requires a new rmit pro f disposal of ;domestic. nda y," age / pit er y only.
A
I Date
Title
iw_._.�....'"v.�.�,_.c,:._ -.., _. -_ .— .w__—'--`_ .___ ....�___•__._. ..............�_. ..,� - �,..�.r,,...._.r_.s_. �i�.vc...__.. .. .__.., .. �. a�.._. �.. 1.,._. ..e...�„e_a,_......>W.;�.._,.� __._` t.. -�
m
PUTNAN COUNTY DEPARTMENT. OF-J,1TIALTH. -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.1072 °575
Nher Heinz Geyer9 Inc o' Address .R. "D. 1 Putnam Valley,, N. Yo
G Cind s Lane 119
Located at (Street y Sec. Block Lot
Ind- ate c nearer cross street)
Lot V Geyersberg
Municipality Town of Putnam Valley Watershed New York City
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
I
p
0I0 e
Number CLOCK TIME
PERCOLATION
T +�
PERCOLA_�C
Runn Elapse
No. Time
Start -Stop Min.
Depth to Water
From Ground
Start
Inches
Surface
Stop
Inches
Water Level
in Inches
Drop in
Inches
Soil Rai;
Min. /in 3ro
1 10°45
11:03
18
24
25
1
18 Min.
2 11:04
11:22
18
24
25
1
18 "
3 11:22
11°40
18
24
25
1
18 „
.... mac- '. . C ...- ..._ :.'....... ..-.. -^ .. _/ °
1 11-:48
12:06
18
24
25
1
18 „
2 12:06
12:42
36
24
26
2
18 "
3 12:42
1:00
18
24
25
1
18 "
4
5
2
3
5
•'ote3: 1) Tests to be repeated at same deg ..xir" te cup_
rates & e obtained at each percola*:*- test- ata to 5e .:.--
reptr. measure,. ents t� �e' ^:::r;, top 01.
40
DEPTH
G.L.
6
1211
1811
2411
3011
3611
1211
4811
5411
6011
6611
HOLE NO. ( 1 )
Topsoil
44
� 1
44
HOLE No.. (2)
Topsoil
Dry sandy Loam
sqLnay
Hardpan
/0 1-- 1) np- _C1
VV 0 V WL L
7211
7 811
:84
.-INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Burgess 8- Behr, Po C Date 7'-7/74
DESIGN
Soil Rate Used 18 Min/l IlDrop: S.D. Usable Area Provided4000 SF+
No. of Bedrooms 3 Sep is Tank Capacit 900 Gals. Typj'ra -cast cone
Absorption Area Provided' By 30 L.F.x2411 width trench.
Other ,
QN_
HOLE NO.
ivame bignature
Burgess & Behr, P. C. S
-
Address SEAL
horsupr5und Road
arme L
Ye LU5L?
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate.Approved Sq. Ft/Gal. b e-----
V
r
PUTNAM COUNTY DEPARTMENT OF HEALTH
-
,,,,,�,- ,�;.�.�.. =-a.: 7Z�;:.
Date September 28,. 19%
Re : Property of He inz. Geyer, Inc.
,Located at Lot '2 Geyersberg9 Cindys Lane., T.'of Putnam Valley
Section- 119 Block 2 Lot 8
Gentlemen:
This letter is to authorize 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 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 14S or
147,. 'Education Law, the.. Public. Health Law, - and:-. -the . Putnam.- ,Cou -nty - Sani-
tart' Code.
Very truly yoUA ,
r
Signed
Val�'
Owner of Prop r y
Countersigned:`i R D 1 e Lovers Lane
984 P t Add e s1 N Y 10579
P.E., R.A., ##
Burgess & Betirp Fo Uo
R D 8 - Horsepqund Road'
A ress
Carmel, No Y. 10512
2253312
" Telephone
U ham a ey,
528 -2.144
Telephone