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BOX 34
04546
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04546
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.... _ . L•.��, Kinibsr,,ly Heller .. .,. - - .__..... .� .
. `a^va ac i..�s. ',+ei �__ Ufa- sm�'cti:.,: 6: ..'.s +'�.i...,� 'j�.•.v -a _•�";, r:,cA �-�-c �: a`e -.i- _.: f.�s.•— _ .. � _ .u.%�5,,,�,.. �/- r .i �..p�a �i �n�:�
Owner or Purchaser of Building Municipality
1;7e, qG r�,dd /� i C/, QSc2Ii l •%F_ 11 2
Bu ldding Constructed by
Location - Street //
AR27Sed /cYI7C/7
Building Type
see2z o e
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 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 EnvIron.mental'Health Ser
.vices of .the., Putnam. Caun,ty, ..Department of..:Health, as - to whether. or not the.
fail to -operate was- oause'd by _the willful or negligent
act of the.occupant of the building utilizing the syst
Dated this 31 day of- August 19 76 Signature X1'_.'/ C�l .. J&Jj"�7
Title Kr ✓��- c�.,�CJi_� rte`
lr 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, Putnam County Department of Health
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL,' NEW YORK
This report. is „to be,col17Pleed by vI(eJl.drilJer and. submitted to. Couply Health De ' arsm.togey�tgerct:f
:� aiy is'c iN fir sa�rip�e In tlrig'vv of fs�f satisf cioYy acferia (7alify be o'r� cerfif% ate SiSniNZiction comp7iTa i i Is, issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME J
Op,Tp ��/CZ %7% PL-111.1112 % LJ
ADDRESS 1.
r. /, Lr'/''/ lei '.
LOCATION
OF WELL
(No. B Street)
d �}
—)
(Lot Number)
���� t?
PROPOSED
USE OF
WELL
DOMESTIC
SUPPLY.
BUSINESS
❑ ESTABLISHMENT
❑ INDU TRIAL
❑ FARM
❑ CONDITIONING
❑ TEST WELL
❑ (sPeEfy)
DRILLING
EQUIPMENT
ROTARY
AIR 6MPRESSED
PERCUSSION
CABLE
El PERCUSSION
OTHER
❑ (Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
(
WbUHT PER FOOT
1:1 THREADED ❑WELDED
r:IE SHOE
YES El NO
CASING
YES �
NO
YIELD
TEST
❑ BAILED
HOURS
PUMPED ❑ COMPRESSED AIR
G.P.M.
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE _- STATIC(Specifyleet)
O
DURING YIELD TEST [feet)
Depth of Completed Well
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
_
2—
AA zi
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WE L COMPLETED
DATE
F REPORT
WELL DRILLER (Signature)
PUTNAM COUNTy D %L'ARTMENT OF .HEALTH
_ DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�..- ic':".� _ •u'— ,'+�`- 'iv',:. c'•y. ,c i_ +...: ;• .�;•�. -. . - .. -..t ,v^• >o...ru' - ".f' use .o>'.�.`•,ss.��_i�..:ty�Cy:, •-. r^- -'• ^. +i7;;.::f •- ,r� -a.e ... .. ,= rsi`k_ =•i '_- y
•i'JrzCr•�^
Date January. 149 1976.. , .... _ ...
Re: Property of
August Damelio
° Located at Gardiner Road ?utnem Valley.
Map 1319
Section j Xl Block /, �Y G goy Lot
Gentlemen:
This letter is to authorize John •S'•, Romeo
..a duly licensed professional engineer x or registered architect
(Indicate.)
to apply fora 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
w,i rli rh i. R m:4i-tor• .;4ri0 -i -n ciina -m i co vhn nnncrt'+nni-i nn ht•. Cai ti..
system or systems in conformity with the provisions of Article 14S or.
1� F.ducati.on Law, . the .. Public Health . Law, an0, the _ Putnam County Sani-
tary-Code.
P . E . , ]yjWy.. # cu its4o
I Northridge Road 6'
Telephone
Address : ,,�,�m� ®,�o-.
Peekskill, • N.Y. 10566�Rg,E�� ="
�'' Cam• h��•55`R ,�
737- 1056
9®
Telephone e;
9e�
m0 ���
O
PUTNAM COUNTY DEPARTMENT OF HEALTH r
- -.DIVISION OF ENVIRONMENTAL.-HEALTH SERVICES
_- -�r -COUNTY- OFFICE BUILDING, CARMEL, N. Y.K 10512 ^ r a
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM . FILE NO.
Owner August�Damelio Address Finer-ty Road I'Anam ' - Valley, NY 10579
Located at (Street Gardineer Road SeclNP 1319 Block Lot 6
6dicate nearest cross street)
Municipality Putnam galley Watershed Peelski11
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Dept
Water '
Wat,er ve
.
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop, in
Min. /in drop
Inches
Inches
Inches
(1) 1 4:07 4 :37 30
19.75
211.50
2.75
10.91
2 409 5:09 30
19.50-
22,00'
2.50'
12.00
4.
(2)1 4:12 4 :41 29 20.50 23.50 3.00 9.67
-4:43'._.. y,,-13.: . 346 .19:75: .;�)Z,2 z�56 .
3 -- 5 :.I5 5 :45 . 30.1 r 20.00. 22.50 2.50 12.00
4
5 ..
1
2
3
4
5
Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil
rate$ 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 SUBMITTED WITH APPLICATION>
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. l HOLE NO. 2' HOLE N0. 3
i
d.-d .-`C.r �.o ;..a^..',".°'..:,, °....., -_ _ - :YS'9 _ `�^JC+�, - yI.:A:`rr"'C, ..e'•it t'R... .. '.i.... ._- w. .... "..r�'�O'u °„ro-a ._p.: .o ..."'.
,_ n 'r"..i. � �r - w�F'r :v6 .C"�.i` a•� V: eia Vae�d'n�a^_.' _ _.
611 . $" Toppoil 911 Topsoil 7" Topsoil
1211 loam containing loam containing loam containing
i8„ some large $tones some large stones soiae large,
2411
3011
36".
4211
48t1
5411
6011
6611
7211
78"-
. 84 11
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
None
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY John S. Romeo Date "JeAbt y U. 1 ,476
-F �—r—
D.
Soil Rate, 'Used 11p1Nltr�/l "Erop S3. y UsableK AraP « SoC� SF
No. of Bedrooms 3,' Septic t6nk Capacity 10001 ,' Maosnr9
Absorption Area Provided By 40 L. F. x2 " x, t enc .
Name 0 Orin S. Romeo Signature it uin=
1-Northridge Po ad �m l
�"
Address SEAL o
1.5566
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
sa ,,`.,� •.T60e X19 - t' /ot V2ArTr'Q" r.b� L/trarry E'sF3EalSsrf -. �. _
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DESIGNED & SUPERVISED BY �" 3, ,BEDROOM HOUSE
FOA
,; RC>MEO- .ROM'ANELLI =AMIGO `f �O �� SOILS RATE �_4a jL�u:GuST
CO.NSCiLTING ENGINEERS GAL...TAiVKz
t z :• �,•a 5. SOWN, OF P.UTk3A:My' VA.'�E EY
1 NORTHRIDGE ROAD 27lW F. r CHES T+Atv1 COUNTY
a-..t� L 3ti TREN 4•
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