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BOX 34
04533
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e ror /t7'(/'it'!'.�-sv.�7f�}:y ��9lY�i .fJ�V J+O��Lt9J -..: fJ •.. dfi�•-=YJ °�- 1 �• �'�e�'r �'�:��.
Owner or Purenaser or builaing
P4,g,g,6 Ck 4/'7g-j- Zer-,
Building Conttructed by
Ealzelj Cg 4,9-w
Location - Street
Building Type
-' : •n�T•= 70.17'' � ' . /if! .�. r ,% "l� i�-� ..,. .. - ....
Municipality'
3
TA-2< M,
Block
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 regulation's 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-
;- vic. es- of., the..Putnam..County.D_epartment of Health as to.::whether or not-the
`• '" `�'ailufe "of't ie�"s'ystem 'tt3 operat'e'wa's" c "aus'ef��"y �t�ie "wiIlfizl 'orn�glgent "`" " "'
act of the occupant of then building utilizing the system.
Dated this `� day of 19J Signature V �'
.° -_ a U
Title ID
Z If corporation, give name
and address)
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,
Put unty, Department
PUTNAM COU,"a � t
DEFT. OF HEALTtl
of Health
I.7'B
i�
L.,_.t aurwsr ; l-l: INVUbIKIAtr
J '.. i. CONDITIONING t_J (Specify)-,
gp
COMPRESSED" '.
Q ROTARY
CABLE OTHE R•
Q
EA9g
AIR PERCUSSION
PERCUSSION (Spoafy) a
LENGTH (foot)
OIAAIETER(rnches)
WEIGHT PER FOOT
(` j:.
(D'RIIVE SHOE''
(WA CASING R E
f.._ "J THREADEL) C_J WELDr:L�
LYECi O
LJYEStdC
-
+
HOURS G.P.M.
CD 'AIR
YIELD (0 PMI
S
':❑ BAKED PUMPED" COMPRESSED
.GoISu"Io ,
3 s,,
MEASURE FROM LAND SURFACE STATIC {Spectly feet)
DURING. YIELD TEST lest)
Depth of Comptetod,Well SOrJ®
SO�t
in feet below Ldnd, surface y
a
LENGTH OPEN TO AQU1fF.R (teaq
S
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (Inches) FROM (feet) . - TO (lee )
PACKED:
gravel pack (Inches)
LANDeSURFACf?
FORMATION DESCRIPTION
Sketch exact location of well with distances to et
:: -two
toFEEi
a
pormanont landmarks:',:`
3Q
GIA,�EL ANi? SAND o :.
r, WELL I S E ;;POSED 18" ABOVE GRADE a
F y;
:
GRANITE' AND QUARTZ o
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GRANITE AND 'Q ARTZa
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yield w,as 4estadF'at
d +ffoee'nt depths during drilling, list.bolow'.
a
GALLONS PER MINUTE
d.
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OMPLETES? k,
DATE:'CJF REPORT WELL DRILLER (Signature). // „__ ,. i_`.� ,;. +:'•<<
PUTNAM COUNTY DEPART11FTW T OF HEALTH
_,.DIVISION ..0 � U_:r3OT1M��.
I CN T T9LIL'�t��'H
Date
' 7
Re: Property of
Located at L��.,i/`.c�L/�c,.�
(4,MA-p'
Block M Lot
Gentlemen:
This letter is .to authorize STA�L�r® ��DE r
a duly licensed professional engineer -or registered ar- chitect
(Indicate) -
to apply fo.r a Construction Permit.for a separatd sewerage system; to
serbe: the above noted property in accordance with the standards, rules
or regulations as promulgated 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 -s in conformity. with the provisions of Article 11�5 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Cci itejsi ned
P.E., • 9
STANLEY I LAN DER
Address
f-
.
AMAWAEK, N. Yo 10501
Telephone `r`�
(Seal)
truly yours,
d/;tom'] .r� _ _ `� �`°7i.....•'-_..._.
0 cr of Property
Address < 1.1'.. e. R J14 Z- /&,fp
0 ? LJ� w'/4- ,
Telephone
2
,C
K S.r�' REVIEW CED
Meets
YES
d.. Remarks
Ilk
- �3�iy � C �`�= �'�`-- �°a`„z:...'tL�'L -- _ 'y -v. .- .a:j�s�, :.Nj. -•a .. r,.�'r. a.� :'q .
House plans 0.K.
. Dosign data sheet
Peres presoaked?
Min., 30" perc test depth
Cont. results for 3 runs
D. Hole log O.Y.
Corporate.Affidavit for other than indivi
Authorization for erigiaeer
- Letter from Water Supply if applicable
If variance requested -such noted on _plans
!ual
. of
DETAILS I
if change is proposed,)
E:tiisting contours shown .kshow new contours)
Slopes for driveway cuts, etc. shown I �/
Water service line location
Footing drain, etc. location ! IV
Top slope, bottom slope of fill ! w jj
Percolation tests and deep test pit location
Septic tank size and conformance-to std.
3 B.R. house minimum
House setback shown
All water wiLnin "u i G . o.i, r1, shown I�
Plan and profile SDS
All - .other _wells- and- SDS...closo _ .200.!
- ......11. shoi -M -or�'re�ferenae�--made :.
Property boundaries (metes and bounds- clearly show
SEPARATION DISTANCES SPECIFIED ONT PLAN
10' to P. L.
20' to Foundation walls i
00' to.Nearest well
50' to stream, inarch, lake, etc. incl.expansion
15' to Curtain drain !
10' to water lire (pits -20' ) !
15' to storm drain i
10' to large trees !
10' from foundation to septic tank s
5' to pipe from leader drain & foo in3 drain
.._
200
rd a
Pw4a
(jk
ti
rz �.LD C11E, CI: LIST
Date: 61("b_q
C. a .''�. ?s +z%'.::'�: .`.`. -.t„i ` � �x.Lt r•c ^. ( -.�-T' • �.:v, ^':'eTi. �..'".c�, :'r S•�{..av ��e...:: _ e .'r• - -
INITIAL SITE INSP.ECTIOI`1 j 'Yes -I No Comments
Property lines or corners found.. .
Can estimate house location'.
Will driveway nized cut
Ntust trees be removed -note these . ..
Is deep hole repres °ntative of entire. SDS area
Additional deep holes needed.
Sufficient SDS area available considering
driveway cut,house location,separation
distances, etc. . . . . . . . .
DEEP HOLE RATA
Depth:
Water elevation: �>
Rock elevation:
Soils. description:
FILTU SITE INSPECTION Insp . 'by:
House located where shown on approved plan
SDS located where approved
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable .
Room allowed for expansion trenches.
Over 50 ft, f..rom .sv� amp, watercourse �.......: -. .
1T tura1---soil- --not- stripped.. or ' SDS° "arrea `
unnecessarily graded
10 Ft. maintained from prop:line and
20 ft. from house
Separation of trench from house,.-well
etc. follows plan .
Number of bedrooms checks ... .
Stones, brush, stumps, rubble :.etc-: greater
than 15 ft. from nearest trench
15 Ft. of peripheral soil horizontally from
trench
Junction boles properly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS
area. . . . . . . . . .
Does, lot draInage appear 0. K. in area of SDS
FINAL GRADING OF .SITE ACCEPTABLE
r
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONPMTAL HEALTH SERVICES
COUNTY OFFICE BUT LDING, CARMEL. N. Y. 10512
DESIGN DATA-SHEET-,SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO.. "
OwneA&V zro �•3-D -z9la'•� /V -V
TNxH y
Located at (Street) ! , F/✓CE 47410 Rft. Block _�_Lot
,k: -ndica e near-s cross s ree
Municipalityl-_' i✓ 0,e 17a>y,,4 4 eV Watershed?
SOIL 'PERCOLATION TEST DATA REQUIRED TO -BE SUBMITTED WITH APPLICATIONS
o e
Number CLOCK MCE PERCOLATION PERCOLATION
Run Elapse Depth to Water Water ve
No. Time From Ground Surface in.Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
rte/ 1.9 -s/ 10' ,04 ��' �8 2 i
/o. 2-1
=- C�� ...i9.•. >".. /d:� /. -. -._.
3 12- /ZR 224
5
1 --
2 %GG �.sri Z,4 GEC /j✓ Ae W"r
3
4
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.
TEST PIT DATA REQUIRED TO BE SU11MITTPPM WITH APPLICATION
DESCRIPTIOR Or' SOILS T'YC0TjV_'1'ERRD IN TEST HOLES
DEPTH HOLE. NO.. / HOLE NO. P ;�- HOLE NO
GoL<svrc� 1opsv /��os4r�
—�---
6"
rr, /
1211 a J�Iy . hq t��N SOLr L�,¢�,.7 \ ���DAyvl• -
18" 4
2411 G
30„ y
3611
42"
48
5411 0
y
9
. 1 ;
.-+... :-.<%- ,a... .. _.. .. -�-- -..... � -- .._.. ..... _.a.._....:- a,......_�._. ,a.... a _.._ _.. ... .7-'- - - ........ `.�,
_ 6.6"
72"
��..
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. /0 014/`x'
:INDICATE LEVEL TO WHIC�T WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date f/- 7
DESIGN
Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity/2Z Gals. Type �iz ��sr C /vc-
Absorption Ares, Provided By qo L.F.x24" 5_ width trench.
RTANI FY I • i atinrD Other
BOX 267
Address
THIS SPACE FOR USE BY BEALTH DEPARTMM,* RMW
Soil Rate Approved Sq. R/Cal.
Date
`3,'Wt-- - 'Pr- he-c4_
00,
>
19,
4
238'76,:.
�'69
0, 915. or,
)k4 'W
raft,
1 300.00 ,
d
The-End, -af •al -Raft S.
TITLE No.!
-7
40)
Sg ? ro
;Curve -.at Barger Street as Shown on Filed
Acp No. 1319.
'PARCEL SHOWN HEREON-KNOWN AS LOT No. 29
ON. SUBDIVISION MAP. ENTITLED'THE DRING FARM"
FILED IN COUNTY CLERK'S OFFICE AS MAP No. 1319.
AS MAP'No.
SUBJECT TO ELECTRIC ANDIOR TELEPHONE CO.
IF ANY, FOR OVERHEAD -ANDIOR
-EASEMENTS,
UNDERGROUND SERVICE.
CERTIFICATIONS INDICATED HEREON SIGNIFY THIS SURVEY
WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE
SURVEYED AS IN POSSESSION, jNo Lines of Possession
OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW
Other Than Indicated).
YORK STATE ASSOCIATION OF PROFESSIONAL LAND
SURVEYORS.
—SUBSTRUCTURES–ANDIOW" THEIR'ENCRCFAC-HMENTS'---.----------.-._----,_--
BELOW GRADE, IF ANY, NOT SHOWN.
'Y b F PROPERTY
HOUSE OFFSETS TAKEN TO FOUNDATION LINE.
PREPARED FOR
PROPERTY CORNERS STAKED FOR BLDG. CONSTRUCTION
PURPOSES ONLY.
NUNZIO 0. LIPARI and
GLORIA A. BERSITO
CERTIFIED ONLY TO:
LOCATED IN
1. NUNZIO 0. LIPARI and GLORIA A. BERSITO
2. THE CHICAGO TITLE INSURANCE CO.
3.
TOWN OF PUTNAM VALLEY
J. HENRY CARPENTER & CO.
PUTNAM COUNTY N.Y.
CIVIL ENGINEERING & LAND SURVEYING
YORKTOWN HEIGHTS, N. Y.
\We. J. Henry C-11—t., & Co. Do Hereby Certify That on Sept. 14.1578-.;
All Certifications Hereon are Valid for This Map and Copies Thereof
Only if Said Map or Copies Star The impressed Sea[ of The Surveyor
Survey of The Premises Shown Hereon Was Made end That This; Map
�Made inlcordance
Whose Signature Appear$ Hereon.
With Th Fl �ees o �aurvf
Alterations of This Map Other Then try a Licensed Land Surveyor is illegal.
SCALE: 1"= 50' DATE: I.Sepi.14,1978
�A_ E �SH. S E �AB 0 L D P.L.S. -N0. T 4 9 �28 6
2.
3.