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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -3 BOX 34 m3 r ' Sri I ���.. ` J ir Im 16 ti , 04525 V� so -E.1t cL PUTNAM COUNTY HEALTH DEPARTMENT [DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR -- Y NO Internal Use Only PERMIT # ❑ ❑ Repair Permit issued in last 5 years 13 Not in Watershed ❑ . ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped Wetland ❑ Joint Review SITE LOCATION _3A FZ CE146E RITOW N 14 !LW �V A TM # OWNER'S NAME VAR - 1V/4H, VtJ PHONE # l i� 7737 MAILING ADORES T,oy r�i9 �! V �Lc-F Y . i IDJ_7 APPLICANT w Name & Relationship (i.e., owner, tenant, contractor) DATE -7110 02 FACILITY TYPE _._,A� PCHD COMPLAINT # r PROPOSED INSTALLER i4 1— PHONE# gy '- ��5- ADDRESS Qu , � q. e,t� y , ,A!p-75REGISTRATION /LICENSE # . /"D X3 Proposal (Include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on Ote nature and extent of the repair. gk; --r'ca 6-77A i4FD. hror`Ga2 PafYo bpz� ly - Sv,- .C_T/vy taxF s I, as owner,agree to the conditions stated on this form TITLE 6WW_&- DATE (owner) - I, the septic instal er, agree to corn ly with the conditions of this permit for the septic system repair SIGNATURE TITLE 776( DATE 7 t0 0 (Installer) Proposal apgroved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built.repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points C. S e UNIT T SML SERVICE' m w i ?a., US'OoAaisa�Cems serial Numbery �a `. Wf11Ch the n 1` L -: .f {". C p�"' 4 a 50.153:179656k�. a� °� , @,� y N Q, Z i AA 7 / 11 ffl4 ly,,f �uw,ess :.� lion Date - I"'.� No 0 fy' osooe umea suua ouwf sue. M nqw nes. >3 z ti ' SEE Aki(ERSE WARNING NEGGt1ABLE OtdY1Pl ; E U S. MIU POSSESSIONS _. 9.0' 9.5' 10.0' Indicate .level at which groundwater, is encountered c�NG Indicate level at which mottling is observed ),5y/jr . Indicate level to which water level rises after being encountered Deep hole observations made by: � mac, Date Design Professional Name: Address: Signature: Design Professional = Seal 07-2009 12:31PM FROM-ENVIRONMENTAL HEALTH 5452757821 T-OTS P.003/00 F- 4w, mix we WL..W 60, 9,04 ce I. vQ w z J tom. � - !� � •' .+'. "� rA 0 `„'gas' 1 E —1 N 0 21�� o t'`3'ar•1 �.! ti� t-' ,. • .. - .•:-m. , � � =i:' .::,- �,E•e:` -.� 'w rr ",�,� .-' .. ,t�` ,.,.:a : � .z i f: 1t11�� I fir', t �• BIron rgmt `; a <� 1 "° 81: 1 "5741, I I 3e �J /� ti �/ u- 24 N �1/ Barge rR a \ 1 .UR °s Y 1 ayyr ` 7 o, 22 r Pond J PUTNAM Vf)LLEY 1 c �q I -` r,'y, a cc pp � $ �� Muse m Adams Corners R t ^ ose Hill Park �1 <r 1 Par?) s "O € ji & u Town k Cam r, IbW.. t �^ of ;ELI ?g. Dawd�clt� "'. '6'• -.,, i a' %OF,�s�x� Cem; t� 20 ` ELLER' p r arRRO "r'Lawson 23 fFr 21 utnal2va j a 'S pLIAY't. oUji-T4! 7AWEY q M 'f19.{� �y_qq . ^. ... .. .. ..r, . -. /...�...,. 9 - - -• j r.. .�� Mg EASI- ST Brook \ . 1 RD STPnwe taaY `r- ----'' ' ~, R,, rub ak 1 O L, Ike i. f 132 I ,� t ,. ay •f h St .-� .I + � 11 • SEE= FOR 1 DJOINING AREA SEE HAG STROM 'S UPI aRID STREET .. GRID STREET GRID STREET GRID' ;STREET GRIDc STREET GpID STRE�I 1 GRID STREET t fiGRID STREET GRID '$ r. .v .. e ,...,�:: { sy.P ,r .FF G 9- :6enedlct�Rd B; ,7, Beecon.Rd 'M 4, ;Dfngl Rd M §. jtiuron Rd - M 4 Mooney Hill Rd :L. 3 Schuyler Rd L }4 LVfike Po,Id Rd "+ J 3 BUttemut.La N4 h t <G L T Boulevard The „B �7 BeavetHdl Rd, ;L S; �.Ducon d J l,fi; -Hutchirison.Rd ..,M.; 4 ,Mount Hope Rd . L•' S 'Schuyllall Gt L 3.:Wtut6eriid M.n 4+ ;Caldwell Rd,} O 4,, i "Ceder.. " $ !8 BedkiFd Rtl M 5 Doansburg Rd : :. L ;,5 E €Inland Ct M ;.,5, Mount:Nimham Gt K, 5 ScotsdalatRdr ::'M 5 ;!YIP Way S. CalJertor ;Rd �R 4f 'G G ...n D - <M 4 Dolie J- '9i 'Che BeeclimontlRd rty Dr ..:r M, 5 olnterstate HCVy 84 M. 4, Nelson,Gt L 1 5 Sebe o Rd r. M 4 Mlllam l �'4j Camden Rtl', R 4 IG }. rrY ... B ;T, >Beehle Rd . .. ; , ..... M 5 Ne :.i I , , G J )9 ,,,Chestnut o, 8` Win dale Rd .:... .. h :5 'Ca n Dr; ri Q, .4 tC r 7 kirien Dr .:..:::. L 4 '.DutcnesslLaka Ct L..:,2 Irvington Rd,. ...:_l.M.. 5 tN!agra Cttl ::: M 4 Sefela Rd } H 8, W ll9 Tn II Ct r L 6 Caml�eron Rd R 5� G H 10. :Church B Bea ?:; B J Bevan R M 4 `D� eman Rd L !'6 Ja Ct - - -..?. L: 5 Nichols- ::: -_K� 6 Seven;Hllls t�lce y,> - :Wixon Rccyy M 5: ;Caroline Or•; N. ti3' . G :9':ConsLtutlon -0r y,.d ,.,.,.,, K 5v �Ea tBo ds,Rd,.l J 4.:JeKre Ct -,.: .... K 3 N!chols;..:. -'L, °5 DtS ' , ,J 4? :Woodchu'Jc Ct'! K 4; ;Carolyn J -, 9, :Craigslde Pi B 6 Blrch -PgirM Gt y y L...4 Nichols Pl L, 5 Shenandoah Ct aG 4..WOOdlan Dr.,•!: M 5::Cen ;ar N 2 H K. 9 :Cross B -:7 Birch t L 6 East roton-Dr .a M 5- ;Jessup Ct _° r.: ne ar e� + R.._7• Blackberiv Ct... -_...i K..4 .Eak Mountain'Rd F „3. ,Joseph Ct,.,.: ....... L; ; 5' N!mham:Rd J. 4 ,Slbbell Ct L 3 YVOOdIen Terrace Chestnut Way a 'S. F _. _ F 5 Mn faro � N 0 21�� o t'`3'ar•1 �.! ti� t-' ,. • .. - .•:-m. , � � =i:' .::,- �,E•e:` -.� 'w rr ",�,� .-' .. ,t�` ,.,.:a : � .z i f: 1t11�� I fir', t �• BIron rgmt `; a <� 1 "° 81: 1 "5741, I I 3e �J /� ti �/ u- 24 N �1/ Barge rR a \ 1 .UR °s Y 1 ayyr ` 7 o, 22 r Pond J PUTNAM Vf)LLEY 1 c �q I -` r,'y, a cc pp � $ �� Muse m Adams Corners R t ^ ose Hill Park �1 <r 1 Par?) s "O € ji & u Town k Cam r, IbW.. t �^ of ;ELI ?g. Dawd�clt� "'. '6'• -.,, i a' %OF,�s�x� Cem; t� 20 ` ELLER' p r arRRO "r'Lawson 23 fFr 21 utnal2va j a 'S pLIAY't. oUji-T4! 7AWEY q M 'f19.{� �y_qq . ^. ... .. .. ..r, . -. /...�...,. 9 - - -• j r.. .�� Mg EASI- ST Brook \ . 1 RD STPnwe taaY `r- ----'' ' ~, R,, rub ak 1 O L, Ike i. f 132 I ,� t ,. ay •f h St .-� .I + � 11 • SEE= FOR 1 DJOINING AREA SEE HAG STROM 'S UPI aRID STREET .. GRID STREET GRID STREET GRID' ;STREET GRIDc STREET GpID STRE�I 1 GRID STREET t fiGRID STREET GRID '$ r. .v .. e ,...,�:: { sy.P ,r .FF G 9- :6enedlct�Rd B; ,7, Beecon.Rd 'M 4, ;Dfngl Rd M §. jtiuron Rd - M 4 Mooney Hill Rd :L. 3 Schuyler Rd L }4 LVfike Po,Id Rd "+ J 3 BUttemut.La N4 h t <G L T Boulevard The „B �7 BeavetHdl Rd, ;L S; �.Ducon d J l,fi; -Hutchirison.Rd ..,M.; 4 ,Mount Hope Rd . L•' S 'Schuyllall Gt L 3.:Wtut6eriid M.n 4+ ;Caldwell Rd,} O 4,, i "Ceder.. " $ !8 BedkiFd Rtl M 5 Doansburg Rd : :. L ;,5 E €Inland Ct M ;.,5, Mount:Nimham Gt K, 5 ScotsdalatRdr ::'M 5 ;!YIP Way S. CalJertor ;Rd �R 4f 'G G ...n D - <M 4 Dolie J- '9i 'Che BeeclimontlRd rty Dr ..:r M, 5 olnterstate HCVy 84 M. 4, Nelson,Gt L 1 5 Sebe o Rd r. M 4 Mlllam l �'4j Camden Rtl', R 4 IG }. rrY ... B ;T, >Beehle Rd . .. ; , ..... M 5 Ne :.i I , , G J )9 ,,,Chestnut o, 8` Win dale Rd .:... .. h :5 'Ca n Dr; ri Q, .4 tC r 7 kirien Dr .:..:::. L 4 '.DutcnesslLaka Ct L..:,2 Irvington Rd,. ...:_l.M.. 5 tN!agra Cttl ::: M 4 Sefela Rd } H 8, W ll9 Tn II Ct r L 6 Caml�eron Rd R 5� G H 10. :Church B Bea ?:; B J Bevan R M 4 `D� eman Rd L !'6 Ja Ct - - -..?. L: 5 Nichols- ::: -_K� 6 Seven;Hllls t�lce y,> - :Wixon Rccyy M 5: ;Caroline Or•; N. ti3' . G :9':ConsLtutlon -0r y,.d ,.,.,.,, K 5v �Ea tBo ds,Rd,.l J 4.:JeKre Ct -,.: .... K 3 N!chols;..:. -'L, °5 DtS ' , ,J 4? :Woodchu'Jc Ct'! K 4; ;Carolyn J -, 9, :Craigslde Pi B 6 Blrch -PgirM Gt y y L...4 Nichols Pl L, 5 Shenandoah Ct aG 4..WOOdlan Dr.,•!: M 5::Cen ;ar N 2 H K. 9 :Cross B -:7 Birch t L 6 East roton-Dr .a M 5- ;Jessup Ct _° r.: ne ar e� + R.._7• Blackberiv Ct... -_...i K..4 .Eak Mountain'Rd F „3. ,Joseph Ct,.,.: ....... L; ; 5' N!mham:Rd J. 4 ,Slbbell Ct L 3 YVOOdIen Terrace Chestnut Way a 'S. F _. _ F rvto 15-0 PUTNAM COUNTY HEALTH DEPARTMENT I_--n 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES IF d Internal Use Only PERPIIT # I-'\— L-1 LV Repair Permit issued in last 5 years U Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 3,9, f Z49kF, dG6RITOWN R "19. VA_G( TM # OWNER'S NAME RL 6VOAP, - /9i4HOyd /PHONE# / %?17'737 MAILING ADDRESS Alf t--W,4 K (/ A-LL9 We %l - _ 1D.-K-7 q APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE -7110102 FACILITY TYPE 4� S PCHD COMPLAINT # r— PROPOSED INS — TALLER ARD 6 ( PHONE # !R -5-L6 'r slu o Sc4k/ A 04L DDRESS 3* �� REGISTRATION /LICENSE # /Q Y3 Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. `r rn /1 "'�. — I, as owner,agree to the conditions stated on this form SIGNATUR�4 TITLE d(ifltt` DATE /o d (owner) _ - ` - -i; the septic instal er, ag'ree"t6 coin ly with1he conditions ofi thi�s 156FW*for the* sept c- system repair / SIGNATURE . TITLE ?" QLt7" DATE 7 (0 to (installer) Proposal approved with the following conditions: s 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 VA C Liz j4-x-pqLcff zp, T ek( ooqy, Lfo w 10- ;Q-OA Iola 00 7-0 r 55 1 ti iP lk v-,. e V u Uotc) 5 �Iwf 6 LL I S-L, IV -93( tvv-r o P- A-cC4t ! 3i 'Z 5b PUTNAM COUNTY HEALTH DEPARTMENT` VI S�10N'=QF -- .~�!!'JAR0NM,ENTA --WEA -T� SIEW Q E S ; .t PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPABR YES o- internal Use Only ❑ ❑ Repair Permit issued in last 5 years ❑ �epair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ l !I Repair within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION . TOWN OWNER'S NAME v 1?1 - !rHt)wi MAILING ADDRES APPLICANT PERMIT 1 ❑ >at in Watershed L� Delegated ❑ Joint Review TM # PHONE # l j 311 7;137 Name & Relationship (i,o., owner, tenant, contractor) DATE 7 10 02 ACILITY T YPE PCHD COMPLAINT # PROPOSED INSTALLER i4go 6p"ffoel2f PHONE # g ' -S SIS� �/'� n SGT} -�' f}-� L.js ►t ', ADDRESS Iq ,�^7REG9STRATION /LICENSE # Proposal (Include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department.rnay require submittal of proposal from licensed professional depending :on the nature and extent of the repair. _ — _ 1, as owner,agree to the conditions stated on this form -SIGNA'I'URE' r�l � Q r}` TITLE- (owner) I, the septic instal er, agree to com ly with the conditions of this permit for the.,septic system repair, SIGNATURE "!� -� h TITLE 4V-4 u-C7 DATE -7 f0 to'� Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer. within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. _Location of installed components tied to two fixed points c. System descri ption (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the . completed SSTS repair will function. .5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. !NTERNAL USE ONLY Proposal Approved Proposal Denied ❑ In pectom's Signature & Title Date p Ex iration Date ,Repair proposal is in compliance with applicable codes Yes ❑ No COPIES: PCHD; Owner; Installer. il� C-3 k �10 y 3 ao 13G �v -T bA-6-3 11 (a Y5. 6O FEr-r TA A;Co r2--c F, $Pa w . ® or XV `Pad I/ AQ ip VIC 69, V4 otso Q! ID A WATER ANALYSIS REPORT SAMPLE NO. 3173 SOURCE: Shear Hill Developers m new well Florence Road- Putnam Val l ey9 N.Y. COLLECTED: April 19, 19.74 -_BY: L ._, Mexlanchuk qpnlne Inco, BACTERIOLOGICAL EXAMNATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. SECTION 068 BLOCK 03 LOT 22 0 per 100 ml. N April 279 1974 y Bickwit P. E. . Di:edo: WELL COMPLETION REPORT 3/71 ' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK w•:::; , _r a i� SR bexom letred by:we, ,il driller _and .submitted to County Health Department together with laboratory report of _. _ analysis of water sample in Icating water Is df s�°ati #ac`ioFy -6 �&6r@ 190" u�fi' ty0bef +tYre'i�"fi61te,ctf��xiiisires aii cvtripliance" °i eti •Y, a :.� REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME C Y l SHIFI.4 GY ADDRESS /% e LOCATION OF WELL n (No. d Street) r (Town) �1 (Lot Number) ' f� �C f� t5 �r 6, C [� 0 1� - � o /U )Y1 V � I C 1l/ ' t U - PROPOSED USE OF WELL UrJ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING E] (spe Efy) DRILLING EQUIPMENT COMPRESSED CABLE, LLB• ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION El ((SSpe ify) CASINO DETAILS LENGTH (feet) J 0 ' , ��yl� DIAMETER(Inches) �j WEIGHT PER FOOT q5-1 © THREADED ❑ WELDED R SHOE YES ❑ NO YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR YIELD (O.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE -STATIC (specify feet) > / U� DURING YIELD TEST feet) l 3 o p Depth of Completed Well 7 in feet below land surface: - . 1 O SCREEN MAKE LE 177 40 AQUIFER (feet) DETAILS SLOT SIZE I Dt ETER (Inches) _ IF GRAVEL PACKED3 / Diameter of well including gravel pack (Inches)' ` GRAVEL SIZE (Inches) FROM (toot) TO (toot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, io at feast two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED TE OF REPORT WELL DRILLER (Signature) ( r 7T __ --I- -_U .. �j��;gj�' .����LY.- f��'`I!''' �%t/ ... -.. _ . .. - �u.,;�• -� z?� �ri%`iJr�/y7.•.`�':/�r�- �. - owner or Purchaser o -Building Municipality 51 -&r4 e 1,11LL e. 11. L Ta Building Constructed by ,42 eaoio Location - Street Building Type Section Block 2a 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. The undersigned further agrees to.accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- -= -ieos: of the -.Putnam •C•ourlty � Department of Health.-as -to. whether or, not the .- failure of'the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this % day of 4,o e. 19 744 Signature. ((' [a- -Tit-le HFKLA CONSTRUCTION INC. x (If c d3VPW j tame and &djE .. 'AC. My, 10541 THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health s%Lt'�Y ✓��f� C:4Je14- eP''S p or l' II I' C l "I S C: r O it 1. C. L II � Mun. c i P a I i. r j7 , *� `"•- �.� * ✓" 1J ��� "'�wF�l;��'�� ��''d'". �!%�i,%3 °L� � i`�jTeias�r�l+-��� '^.' `� w �...:_:,;`.` . . c _ V�:v��i`�S °�9g �+rdl= :.::.; �::o:: ;e ,�$•.t � "-i:y� r^� ,::= �'.: -;w• "Building G nstrucLEd by �- Section fv� -el" ee i ?0/ 'Locatl.on - Street Building Type �31och ' Lot GUAR_�iiIT�r OF SErARG7'F Sill ;�, ^Gr SYSTl;i1 I represent. that I am wholly and completely responsible for tho location, worimianship, material, construction and drainage of the sewage disposal system serving tl;o above described property, and that it has been constructed as shoi•m on the approved plan or anproved amend--Ynent thereto, and in accordance with the standards, rules and re gulations of the Putnam County Department of. Health, and hereby guaranty to the oi:mer, his s.ucces- so.rs, h.nirs or assi.vns, to place in good. oneratin` condition any part of .said system constructed by irie i -!hich fails to operate .for, a poriod of two years �..- >'nediaLely follo:.iri the .date of initiai use of th-- sewa`e disposal :yS tem, or any repairs :ride by 2rie to such system, except T,�h�r� the fa.;:lur e to operate _oroerly is ca�.s�:d by the ;ai].1fu1 or. negligent act of the occu- pant of the building utilizing tl�e system. The undersigned fi)rther ar rees to accept` as conclusive the de- termination cf the Director of tixe Division of Environme;zral Health Ser- vices of the Futnun Covmt-, Depart -n -ent of Healt'n as to whether or not the failure of tr.e system. to aperate was caused by the willful or negligent .,act.. of the - oc- cupant of the building utilizing the sys_ten. v . Dated this 23> day of. �.%v�P 19 7. Signature 'Title (lf corporation, give na:ie and address) oA (59 THREE (3) COPIES ARE R EQU.IRED WITH T�;REr (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COI%113,E`i.'ION, 14ILL BE ISSUED. GUARANTOR IS R QVIRED TO F11LE NOTICE OF DATE OF FI ST. USE OF SYSTEM. Division of Environinental Hea].th Services, Putnam County Department of HoLalu -1 N LOS .2 .1 cS.— S- 29'45=30 =W o= - 12 .50' r m ..... E�,.;, -a- �a t •T, —=�� r'. •• -S•Y. - . u.. Q i. .r 9 f,. . ,e -.. - -�✓.,� . �t ..�vG,`�'�s' V . _ .':va a &'^�:.... . .., oo .. .1 •Z0 .I hr ' ra0' '$ . q CD 51.0 120 om� PP OV a° t 1 t 0 O_ W R3 0 ' _ F ALG2 9 •" °� _ 1 ,r 32. PUT COUNTY 0 ALT 0 �. = , 11 I ,•�• -.�_ t ^1. f - _ BY ........_...........' R E U. 't c t DR. { DIRECTOR, DIVISION OF V WVIRONMENTAL HEALTH SERVIp Q Tad �L 1F I / w� o i r ILr d- t -AREA: 43,56 a r ti l �Z6 m 11T Y4 126 m z . .9 ' - P �5�, • - �- -�'� "W`:..� ' '::J+�id :'':u' 736 TO 3103 fVtSTON, MAP RF_P_BO.PE &TXKhLRYl�9ShiE pR,ldf_E93M, MAP NO. 1319. �^ TOWN' TAX DES IGi A_f((j ' J• H SEC'"ktiA:' - osA x V 11~ • ' r, .w a 'PU!Nib COUNTY HEALTH "DEPARTMENT 4 -a d, I = DLVISON :OF ENVIRONMENTAL• °-HEALTH SERVICE$. John M. Szmmons,.M D. s r. Deputy Commissioner of Health FIELD AGT:IVITY,REPORT Sheet 5 .� of k INSPECTION`• -NA ME _ :Qrig. Routine. Orxg: Complain AADRE"SS AM ; A rig. Request. $- NO. Street iKunic`ipali`ty T)(V)(C) Compliance. Complaint Camp MAILING'ADpRESS Final P.0.. Brix Post Office ZipiCode- Group.$Ilaness. on t me t Eton TELEPHONE ' Re n -sPect opt PERSON IN 'CHARGE { Field Sa mP l in $ and Y ,t: OR INTERVIEWED :° �'p tp�-r, � , . ieldConfetence:` `Name a -nd Titic` Others 3ATE�'Q /E_ /B ia' TYPE AGILITY - i. -, t TTq ARRIVED / TIME LEFT 7 Explain 'FINDINGS tlDU�s� t S' Of-i N�5 aCG.iiP p C-� ' =? P.L`�T MC —` ". ., f Y : F .:_ - . v G ��� ..� � D Syr ._ W�p.,� �,�,A�-c�a+� •A cco�o ra c To P4a n( 3 77,77 77 ern °P�oe-�27Y c c. , t ?a , ,.F _. 4 . ' INSPECTOR 'Vr�o�(M t 44 t m tELEi. ONE Signature and' Title PERSON "N CHARGE QR INTERVI`EWFD, - a A I' acknowledge receipt 'of a .copy.. this ` SIGNATURE 7F . U Adtivity iteporto TITLE, �,��,_ .11 ll,�!��,l 417,�:�',`.,'i`,7%,, , Z-"",,';, ��,' "vel ,b, ,NN,�, 9� � I 1. 11 11 � �., � � - � , 11 , ., " 'g, , , , �� 11 It, • , ,�,,, ,: , , , � ,� , , , ", 44 � , �,l 4�. :� , , . �,t , , I ., ... . 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CORPORATO -OM-- I TUCAT 02-*1-'--*�,,-, VOR P'E=T "FSQMMM bt PUTNAM Co U -M.,SARTARS -CCDE (p3sabOA rp print in ink Condoaonar of Hialth "In th® m2t4dr,-,6f a xi pplication fo � ww4ze ZA5 j, 1.`-: thi 111 im to A6 c c=� 11-14 - — — — — — — — — — - 4 R ) j©>, Ci c= m® .6 g6 &9 led �6 clV dz; i—:s Ems Hom za= & M% 2 cWj- Nag ffai� a&387 - - - - A-cif T"t 98Z X WaW cT AW�7 .--- D adopWd anmam � with respect to the approva requested and an aubcaqmnt v4ts'.ralating thereto, 'Sworn to Wore we thi i� .14) day Signori q,✓s 1- Title c:* otau k.- UjMMA; fo r rk statc.0 New motary; Pu.W W i0t, S - tO, -Vdach"ter. N6." 6C DOM. 'I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION .OF,aENVIRON` . ti AL HEALTH ._ __ MENT SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 :_.DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO. Owner LTO. Address iyEA,e lhz L Located at (Street. Sec. ©68 Block o.-7 Lot ZZ 6idicate neares cross street) Municipality '�yTNA/J� 4,1,0LL.E 31 Watershed �DEE,��SXiG� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS _._ Hole Number CLOCK TIME PERCOLATION PERCOLATION Run El apse p o Water Water T ve No. Time From Ground Surface in Inches Soil Rate- Start-Stop Min. Start Stop Drop in Min. /in drop -Inches Inches Inches 2 q.'/ 7 9.'3z /S 8- 6 /%•^/- / 3 5 1 2 3 4 Notes: 1) Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. o1 „mini-,, mr�a ei iraman't R t n he made from ton of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION �BESCR,1FTION: ©F a S ILS EN0,4U�1TERED - IN_ :.VEST,; ;HOLES EPTH HOLE NO. HOLE NO. Q HOLE No. 7 �726�-s T .L. %/J ,fO /L_ TfJ/9 ,J 72o10 ii 24 8rriPoavn/ GaA r. . 54.' 60 66'' T2 r r M0 ACA 0n1CAr'E LEVEL AT WHICH GROUND WATER IS ENCOUNTERED NDICAM LEVEL TO WFI H W TER LEVEL RISES AFTER BEING ENCOUNTERED 'EBTS �E BY 11 h'E/!/.�y C'•Q�i�Eie/7��2 �'` �, Date DESIGN o?Z Rte UsedMin/1 "Drop: S.D. Usable Area Provided 'oc'o s o, of Bedrooms - Septic Tank Capacity /too Gals. Type CoNc bs orp ion Area Provided. By x.16 L. F. x24.'1 width trench. Other me ,� F•�o�m� -oo�z .E. bignature tL74- -7,9k/ /h• t- t, el vx�e Ae o. SEAL THIS °ACE FOR USE BY HEALTH DEPARTMENT ONLY: o Soil Ete Approved 1 7 q Y c S . Ft Gal. Checked b F� "' •SNEA,e 4z c OEli. 1,70. _ .. ru';✓ Y/,- PurNAo .SNEAK f/iLL DE "Y � T,p Building Constructed by C[ d ,r-41 CC- Location - Street Building Type © .1, 8 Section e7Y Block 29 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. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of En.vironnmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure...of the,. system to..-o;p.s:rate was caused by -the, willful 1 or negZigq. t- -- act of "the o•ccuparit ofJ_ "the' building utilizing the system.+ Dated this 21 day of Va4e 1919 Signature ��Q.f�(,� ]��G+.W" Lft 4Clz.c W TitleHEKLA CONSTRUCTION .. INC. If corporation, give name and 9da dress) ,•D. R.F.D. # d - - - - - - - - - - - - - - - - --- - - - - - - - - Ln.r. MAHOpnC. 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. Division of Environmental Health Services, Putnam County Department of Health T. WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HE. 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING • CARMEL, NEW'i This report is to be completed by well driller and submitted 10 County Health Department together with laboratory report o 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 . �� nb! . r OWNER NAME //1 0v / ✓ /•' L � � r %,( 'f Cs .S LOCATION OF WELL (o. A Street) own (Lot Number �,� a k'4 � - , C OL171LAM U N II F ( AL Y. 7 � • PROPOSED WELL ® DOMESTIC ❑ ESTABLISHMENT ❑ }ARM TEST WELL PuaLiC AIR OTHER El SUPPLY ❑ ❑ INDUSTRIAL CONDITIONING El (Sparl(r) ECUIPMFNT . �� nb! . r OWNER NAME //1 0v / ✓ /•' L � � r %,( 'f Cs ADORES$ M n /27 0 I- /;) ` 2- A LOCATION OF WELL (o. A Street) own (Lot Number �,� a k'4 � - , C OL171LAM U N II F ( AL Y. 7 � • PROPOSED WELL ® DOMESTIC ❑ ESTABLISHMENT ❑ }ARM TEST WELL PuaLiC AIR OTHER El SUPPLY ❑ ❑ INDUSTRIAL CONDITIONING El (Sparl(r) ECUIPMFNT ® ROTARY ❑ 'AIR PERCU5510N El PERCUSSION ❑ OTHER CASING DETAILS IENGTN (!**t) )(t '�k, DIAMETER(inches) WEIGHT PER FOOT L(5- R THREADED ❑ WELDED X YES NO YES NO YIELD TEST HOURS C1 SAILED ❑ PUMPED © COMPRESSED AIR G.P.M. YIELD (O.P.M.) WATER .- LEVEL MEASURE FROM LAND SURFACE- STAtIC(Spee1 /P teel/ / a. DURINO VIEW TEST feet) LD f 3 U O Depth of Completed Well ) � In feet below land surface: �� ,a T:/ SCREEN MAKE \ ' ttNGTH OPEN TO AGUIfER (toot, DETAILS SLOT lI DIA(AtrtR pnehes ��. IF GRAVEL PACKED, Olamater of wall lndvdfnp gro+�e1 pock (Inches): •• 6R VE SIZE (nehea) ROM (loot) �� i0 (leaf) DEPTH FROM LAND SURFAG! FORMATION DESCRIPTION Saofeh *meet location of Mall with dhlaness, to of hest two permanent landmarks. FEET to FEET - n • i ( l If yield was tested at different depths during drilling, lid below • FEET GALLONS PER MINUTE DATE WEIL COMPLETED tC ' [y�t 7t DATE OF REPORT Y�2.C),.:' Z! /4 ")r/ WELL DRILLER (Signature) i 1 f l/- k'iLt,LtC.7 IC}'C•Qn.1r= 4-' .1 -.1. y. 77 -T :.-i, September 19, 1986 Mr. John Karell, Jr. DEPARTMENT OF HEALTH Two County Center Carmel, NY . 10512 Dear Mr. Karell: In Re: Construction Complieance Barger St. & Florence Road PV TM 68-8-1, Lot 22 Enclosed you'll find photo copies of the three items you requested in yourjetter of August 22nd. These copies were obtained from the ,Putnam Valley Town Hall records. 1. Well log'from well driller 2. Bacteriological analysis of water supply 3. As-built plan prepared by the designing engineer or architect. I hope this completes our file to your satisfaction. Sincerely, Janice R. Lewis 41 . Jam..s H. Seaboldt, L.S Jo HENRY CARPENTER CO. PROFESSIONAL LAND SURVEYING Established 1868 2070 SAW MILL RIVER ROAD, PO BOX 174 YQRKTOWN HEIGHTS:;•N.Y. 10598 . -. August 29, 1986 Mr. John Karell, Jr., P.E., Director Department of Health Division Environmental Health Services Two County Center Carmel, N. Y. 10.512 RE: Your letter of August 22, 1986 - PV TM 68 -8 -1 Lot 22 (copy attached) Dear Mr. Karell: ' 'I-el. (914) 962 -2689 In accordance with my wife's phone call to you today, we are returning a copy of your letter addressed to Mr. & Mrs. Jennings Lewis concerning engineering plans for their septic system. As noted in that phone call, I purchased the surveying records of Mr. Hans E. Frommholz in September 1975. Mr. Frommholz subsequently died in 1978 and I:_have no knowledge of any of his engineering records. Yours truly, James H. Seaboldt, L.S. /eas Enclosure co DAVID D. BRUEN F W �inn4 �. JOHN SIMMONS, -M.D. County Executive t:" rl, Y �� Deputy Commissioner r rV DEPARTMENT OF HEALTH Division Of Environmental Health Services August 2,: 7- 98,6._::._ :. .;..:•.:::f�::'�::: _ Jennings & Jance Lewis Florence Road &.Barger Street Putnam Valley, .NY 10579 RE: Shear Hill:Development, Corp. Construction Compliance..;:B.arger`;St. Dear Mr: & Mrs.., Lewis: & Florence. 'Road," 'PV 'TM .68 -8 -1 Lot 22 Recently an inspection of the sewage disposal system and well serving the above. captioned residence was conducted by a representative of.this Department. .Subsequent review of Departmental files indicates that a Certificate of Construction Compliance has not been issued for the completed sewage system, therefore, final approval of the construction of these facilities was not granted. While we realize the difficulty involved in locating older records, at this time it is requested that.you attempt to locate the following materials and forward copies to this Department to canplete our files: 1. well log fran well driller. 2. Bacteriological analysis of water supply. . 3. As -built plan prepared by the designing engineer or architect. Procurement of these necessary documents may be facilitated by contacting the. well driller, engineer, former owner and/or Town. xqu, S.boJd_.be aware:: that• proof zof approval--of thec,sewage- -and :water- supply facilities serving''this- property"may.'be required relative to future sale or refinancing of the property. Therefore, it is in your best interests to obtain: the above- captioned documents. If there are any questions or this Department can be of any assistance in this matter, you can call the writer or Mr. Hodgens at 225- 3838/3833. Very I trul ' yours, hn Karell, Jr., P.E. Director Environmental Health Services JK:mk cc: E/A H. E. Frommholz, PE M O'Dell BI File F /l /jk,/jay -4 TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641