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BOX 35
04626
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04626
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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of .Environmental .Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Located at'�� -!
Subdivision
Owner 81,17-4119 4? ,44-1?,6 5 / N C
Building Type /� 'ft �L' Lot Area - /' co.5 -rfC
Number of Bedrooms
C�fj r�
PUT/► A' �� �� C � � r.
Town or Village
Section
Block f 2 L
Lot -5�; Job
Address .157- _5Tt/�`?i�1 �1 ^ij d 6vAL Nj!
Total Habitable Space Square Fee?
n
Separate Sewerage System to consist of Gal. Septic Tank / lineal feet X SC �i width trench
To be constructed by R1!�N/ 4--A le X CAS! C04 /9 Address ole M✓ "e.04,/0 �c'eksk/ %/
z
Water Supply: Public Supply From
)�
Private 'Supply to be drilled by NUERs'On/ tuCLL Ct,eS
Address �4 �L `rE ,p -.frR E E r - ,eurmo M x4,e-z z;• y n✓ �
Other Requirements
I represent that 1 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 to and in accordance with the standards, rules and regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and. a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, 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 approved plan and that said well will be installed in accordance with the standards, rules and regu a lens of the Putnam
County Department of Health.
�UC 9-' y 2
Date / Signed �� "y'�`�-� -�-� / P. E. 11 R.A.
Address - S07 e _1 acc/. /YI L. Ae/6 /ER_ �(� `vrk. License No, 12,10c,
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for .cause or may be amended or modified when considered necessary b the Commissioner of Health. Any change or alteration of ction
requires a Pew p mit. Approvetl for disposal of domestic san aryCsewage, /or iv, a ater supply only.
Date gip( By Title 6
P
o j • - U"Y'N AM- COUNTY 'DEPARTMENT CAF - HEALTH
Division of Environmental Health Services, Carmel, N. Y. '10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
.74/%4/•q/)7 /444rj`
Town or Village
Located at i ywz e ;r%,
y
Section 1 24)
Block
Owner 0V7-1V,9 n%
Lot 3-5
Job
Sr L•'��'C /�t�"'C�` /dL
Separate Sewerage System built by
t diVJ� �t2 -
- Address ���✓ // l
yaQ Septic Tank 2¢0
Consisting of Gal. Se
lineal Feet X
a —width trench
3�r
Other requirements
��yy
/•..-Ided ,J ' ej,-a e
Water Supply: Public Supply From
Private Supply Drilled By %►'� M .d A✓ r/V DF �E'3 0/✓
Address - ,sT,cF 106112y:107 11,414Ej"
Building Type eywc tw No. of Bedrooms 3 Date Permit Issued
Has Erosion Control Been Completed? 1 CJ
certify that the system(s), as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
'tached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued by the Putnam County Department of Health.
\ %� y
®C % 17- / j �7 ` ✓ Certified by P.E. 41� R.A.
Address gaze lj !L/ A)II.d Rl� dFlo. ? WiW &j&4r License No. )24411)
V.
son occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
s resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
end the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
modification or change when, in the Judgment of the Commissioner of Health, such revocation, modification or change is necessary.
e
_ 5067
YORKTOWN MEDICAL LABORATORY INC, 1
P.O. Bo$ 99 321 Keen Street
sm.HeIghts, N.Ya.10598 245 -3203
DATE COLLECTED
.REWL.TS OF'EXAMINATIOM OF WATER
DATE RECEIVED
1IZG0R .0 0 ORMATS 10/30/73.'
0 0
kGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED
ST. BOX 262- PUTNAM'VALLEY NoY. 10579
DOINT
wiEZI, -- #35
5
PER ML. (Agar plate count at 350 C). COLIFORM GROUP (Most, probable No. /100ml.) , .,HARDNESS, TOTAL -ppm
I,ESS: THAN 2 0 2
ITS ppm. NITRATES (as N) - ppm IRON, TOTAL - ppm
(F) - m9• /1•
ults'indtcate thai`tiie= �vai�s vrae .Yr'+S of a satisfactory sanitary quality when the s p e was colle yt
A. H. PADOVANI, M. T..(ASCP)
i
Da
Re: F r o p c- Z, t o //v C'
Located at
/0 4go Lot
Block
G a n ", 1. e n-. 'Zi -n
This let-te�, 1� to
a d uly. l_:?'___,_., 11 -D -e c c
S
--and —'s,
tonne o.. se o
'�o suj-=� cons—
c e o
P � r�'
ILL7, Ed=�'---*--rl Law. e Pl,blfc -Hnelth Law, -he u ✓-na
U-
tary Code.
Very truly yours, IA✓C•
S i d
7
Coll-ntersi C-1 ne .-
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Addass l
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Tele-oiicne
20,70 5,4kl
Address
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EN(SISL
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OF
TC�S
Da
Re: F r o p c- Z, t o //v C'
Located at
/0 4go Lot
Block
G a n ", 1. e n-. 'Zi -n
This let-te�, 1� to
a d uly. l_:?'___,_., 11 -D -e c c
S
--and —'s,
tonne o.. se o
'�o suj-=� cons—
c e o
P � r�'
ILL7, Ed=�'---*--rl Law. e Pl,blfc -Hnelth Law, -he u ✓-na
U-
tary Code.
Very truly yours, IA✓C•
S i d
7
Coll-ntersi C-1 ne .-
�-kd'
,e
Addass l
Z/9
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Tele-oiicne
20,70 5,4kl
Address
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EN(SISL
f UTNAM ACRES, INC.
_. ,O urc.t ",c si:r ox Idin, �
_ Milgor Associated Incg_�_
c/o M L Miller
78 Vaughn Ave., New Rochelle, No Yo
Location - Strec t
Putnam Valley9 N. Y.
r.�.1. ity
S--otion
1280
BI oc1r
bedroom ra_n_ ch
Bui1c1
Type loo -t��'
GUARANTY OF SEPARATE S sWAI.G E SYSTr21
I represent. that I am wholly and completely responsible for tho
location, wor-Imanship, material, construction and dz'air_ar e of the se��a� c
disposal system serving the above described proper'ity, and that it has been
constructed as sl,oi•m on t11 approved plan or approved aiie ,.ment thereto,
in acc.brdance ,;ith the, standards, ru' es .and regula".ons cif t'CI.E: PtctC1olil
County Depart Lent of Health, a.n.d her. eby ,Tuarar:t;T to the Gbn? r, his succe "-
sors, r.nirs or assigns, to place in p-oodV operating condition any. part of
said systa�l constructed by re :•�hici fails to on rate for a period of tv;o
Years ].I7ITn�dia lo',:il? the .datE3 of i.nit7_ ai use of th se�•;age dis )osa•1
tcly fog
system, or any rapairs :r;acie by me to sue ?,z S�FS -.0j -%, except who-re the failure
to operat - _- 0-- ").:.;rl y is caused by the ,•:illful or negligent act of the occu•-
Pant of the building utilizing tl�e systel"l.
D-ie under S4Smed "urther agrees to accept as conclllsi.ve the de-
: teI'1111.n it:i.On of }le DireCtoj' of t- Ii 1. \rl lOT: Uf �lviron-r_ental Health Sar--
vicc .s of the P., Connty Depart.m&mt o10 11ealt'n as to Hhetler or not the �
......failure of the system to ),o'-rate tdas caused by the willful or negligent
.. e..e -. - n.� -�ni {•�` 1 � ��.' 1 ���Si- � I.,- �I,.,n �, �.1.�.l � r�.17U ._t � � .�. .i� -
'`Ct .. Ci vL•'�h`:v •1i-V •.. 1..�X t,- .O:.i:�la - ✓, al�,V- l.c.Tl. L
Dated this day of 1�3 Signature s '. � _�
'Ti tle
(If corporation, give n r: e,
and address)
Hewitt Street
.lake- Peekskill
THREE (3) COPIES ARE, RIE UIRE.D W �21I TIiF ?r � (3) COPiL'S OF FINAL PLANS BEFORE
CERTIFICATE OF COMJ? _1ET10 ? HILL BE ISSUED.
GUAFtAidTOR .�S n 'QUIR D '�O FME NOTICE' 0r DA1 "E OFD ..RSA. USE OF SYM:EM.
Division of Dmvironmental lioalth Serviccs, Putnam County De :partment of ticalt:i'i
.0 —�- I 1UNI REr-bRT P�ITNAIVI COUNTY DEPARTMENT OF 1-1EALTV
3!71 -2 Di'vision of Environmental Reek, Services
COUNTY OFFICE BUILDING - CAF(MEL., NLW Y017K
revolt Is to Lc con-ipleted by. well driller aCounty 1*!,*,,, d submitted to County Health Department together with .laboratory report ()f
'
:analysis of vvate . I- sample indicating water is of satisfactory bacteriM quality before certificate of construction compliance is issued.
7 T
REPCRT*M�USt BE SUbrAl' ED T WITHIN-30 DAYS OF WELL COMP
OWNER
NAME z9
PUTNAm ACRES*, INC -
ADDRESS
78 VAUGHN AVE., NEW Ro . C*H'ELLE , N. Y .
LOCATION
OF WELL
:PROPOSED
USE OF
WELL
(No. L Street)
/7'
BUSINESS
EYI-DOMES C ESTABLISHMENT
PUBLIC
SUPPLY INDUSTRIAL
(Town) (Lot Number)
FARM TEST WELL
rl AIR'. OTHER
CONDITIONING El (Specify)
DEILLING
EQU,
rj ROTARY
COMPRESSED
AIR PERCUSSION
CABLE OTHER
El PERCUSSION (Specify)
CAS114G
DETAILS
LENGTH (teat)
,-,Z �
DIAMETER (inches)
& .
WEIGHT PER FOOT
1 /3
R WELDED
THREADED
DRIV
E].E SHOE
YES 0 NO
V S CAS!NG 'ROUT EDf
YES nNO
- - -
YIELD .
TEST.
.
BAILED
. . , I -:,. . . HOURS G.P.M.
F1 PUMPED COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND S URFACE — STATIQ (Specif
YIELD TEST [feet)
Depth of Completed Well
in feet below Land surface:fl
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER F E R (i�;t, T
SLOT S17E
DIAMETER (Ir
GRAVEL
PACKED:
L Diameter of well including gravel pack (Indhes):
GRAVEL SIZE (inches)
FROM (feet)
TO ([Dot)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two pernianent 7andmarks.
FEET to FEET
V
-A,
If yield was tested of different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE NVELL50MPL9TEED P TE OF REPORT
DRILLER (Sic
11
-1
PUTHAM COUNTY DEPARTIENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERITICES-........
`COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
d
::DESIGN DATA SHEET- SEPARATE SEWAGE, DISPOSAL SYSTEM FILE NO.
Owner ,�� ✓i�"N c; � 5' /db��'. Address % �c�r�t� ';n,��i r�i�ry�. }✓ Al- b�
:_Located at (Street 6dicate f =��:ry P 40, Sec. Block i�� Lot &A
hgarest cross street)
Municipality �r�it� ,v� `�!- Watershed3l d- �--
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
.,Number CLOCK TIME, PERCOLATION PERCOLATION
RET El apse Depth to a er Water ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
•Inches Inches Inches
1 !7-'a A yiz, r J-3,
.r?
-go /h "W / , a
2 0,116 4 : 0 d :3" 'd di
4 ,
C� f J
5
1 ..
2
3
9
Votes: 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 measuremekit's to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
r...._ �_. .• .: ESERIPTION OT: SOILS Fl\TCQUNT _TPA T IHQ _ a
r
-�'�TH 'HOLE NO. F HOLE NO. HOLE NO sr
So
I!{
811
e7 a rr
'i
i v
I,
- pr-
If/
' V
71� i1 J
311
'T n� "�.
41-d, 1
MICATE LEVEL AT WHICH GROUND WATER T_S ENCOUNTERED 1
MICATE LEVEL TO WHI,QH WATER, LEVEL RISES AFTER BEING ENCOUNTERED
]STS MADE BY IJ �'� �}' �i �����/i�.� " L'c� • Date /p e,
DESIGN i
iil Rate Used .7 Min/1 "Drop:
S.D. Usable Area Provided _ -5'o6o a' c •i-
} o of Bedrooms & Septic Tank Capacity 960 Gals. Type
)sorption Area Provided By �L.F.x24'1 a.
JAF 0,
:me 31.- asp9a,� .6. Signature
.dress
: SEAL
e�7vt-, Ts , A. V - -I&
If 1 .1 T k-,t
CO A/6' .
zc1�—
b",
:IS SPACE FOR USE BY HEALTH DEPARTMPINT ONLY:
it Rate Approved Sq o Ft /Gala Checked by Late
r,
i
"'wo
G J / J/O l w i'il I F/ (D
LOT 36
60 Bit i
t. / 1 z: a I
IF rr
0
(0
PROPOSED 'I'l
WELL WELL ON TN
LOT
ll 560 5 8. 6.4 5-63.00-0
'00'00'E 56.82
9
ExIS "4
616
r-,Mry
o,
14
zo "v
Fu'
.11� Up
ov p
&%popos
ckv. OR%,
N
VERT- C- 4
NOTES
30" PERCOLATION rE$T RESULT = I" DROP if
7' DEEP TEST FOR ROCK OR WATER NO ROCK. G
APPLIED RATE =_1 A— GALS. PER S.F. PER Di
MINIMUM DESIGN RATE. = 300 GALS PER.S F. F
SEPTIC TANK CAPACITY= NO. BEDROOMS X-30
DESIGN - SEPTI 6 TANK CAP. — APPLIED RATE:
900 2314 L,F-.LINEA6
MINIMUM TRENCH WIDTH- 36, MINIMUMTRE
ABSORPTION FIELDS TO BE GONSTRUCTED 0
FIBER PIPE OR EQUAL WITH STANDARD PREQ
JUNCTION BOXES AT INFLUENT CONNECT EACt
SOLID FIRER PIPE AND CONNECTION TO TAMP
TO BE 4"SOLID PIPE. TANK CONNECTION TO
4" CAST IRON A MINIMUM OF 10 FROM HOUSE
MAXIMUM LENGTH OFSINGLE FIELD- 602.
ALL CON . STRUGTION TO BE DONE IN AitrORAP
REVISED NY S. BULLET IN - 1, PART III, AND L
CODES.
BUILDER TO KEEP AREA FREE FROM CONSTRIJ
DESIGN 5 RATE BASED ON FILL I CIN 15 MIN.) r =6-
O 30" PERC TEST
7' DEEP TEST
J. m
more:. '
APO *aO
Oli. ke"
64.1.0
60. 0 4
04"0' 4* O�
4*' 164;%NZ, '-0
Z jj, 5t e
el4l��
40.
e '04, f OF
C'v
61 IV4
LOT 35
1.005 AGIfES
so,
G J / J/O l w i'il I F/ (D
LOT 36
60 Bit i
t. / 1 z: a I
IF rr
0
(0
PROPOSED 'I'l
WELL WELL ON TN
LOT
ll 560 5 8. 6.4 5-63.00-0
'00'00'E 56.82
9
ExIS "4
616
r-,Mry
o,
14
zo "v
Fu'
.11� Up
ov p
&%popos
ckv. OR%,
N
VERT- C- 4
NOTES
30" PERCOLATION rE$T RESULT = I" DROP if
7' DEEP TEST FOR ROCK OR WATER NO ROCK. G
APPLIED RATE =_1 A— GALS. PER S.F. PER Di
MINIMUM DESIGN RATE. = 300 GALS PER.S F. F
SEPTIC TANK CAPACITY= NO. BEDROOMS X-30
DESIGN - SEPTI 6 TANK CAP. — APPLIED RATE:
900 2314 L,F-.LINEA6
MINIMUM TRENCH WIDTH- 36, MINIMUMTRE
ABSORPTION FIELDS TO BE GONSTRUCTED 0
FIBER PIPE OR EQUAL WITH STANDARD PREQ
JUNCTION BOXES AT INFLUENT CONNECT EACt
SOLID FIRER PIPE AND CONNECTION TO TAMP
TO BE 4"SOLID PIPE. TANK CONNECTION TO
4" CAST IRON A MINIMUM OF 10 FROM HOUSE
MAXIMUM LENGTH OFSINGLE FIELD- 602.
ALL CON . STRUGTION TO BE DONE IN AitrORAP
REVISED NY S. BULLET IN - 1, PART III, AND L
CODES.
BUILDER TO KEEP AREA FREE FROM CONSTRIJ
DESIGN 5 RATE BASED ON FILL I CIN 15 MIN.) r =6-
O 30" PERC TEST
7' DEEP TEST
ll 560 5 8. 6.4 5-63.00-0
'00'00'E 56.82
9
ExIS "4
616
r-,Mry
o,
14
zo "v
Fu'
.11� Up
ov p
&%popos
ckv. OR%,
N
VERT- C- 4
NOTES
30" PERCOLATION rE$T RESULT = I" DROP if
7' DEEP TEST FOR ROCK OR WATER NO ROCK. G
APPLIED RATE =_1 A— GALS. PER S.F. PER Di
MINIMUM DESIGN RATE. = 300 GALS PER.S F. F
SEPTIC TANK CAPACITY= NO. BEDROOMS X-30
DESIGN - SEPTI 6 TANK CAP. — APPLIED RATE:
900 2314 L,F-.LINEA6
MINIMUM TRENCH WIDTH- 36, MINIMUMTRE
ABSORPTION FIELDS TO BE GONSTRUCTED 0
FIBER PIPE OR EQUAL WITH STANDARD PREQ
JUNCTION BOXES AT INFLUENT CONNECT EACt
SOLID FIRER PIPE AND CONNECTION TO TAMP
TO BE 4"SOLID PIPE. TANK CONNECTION TO
4" CAST IRON A MINIMUM OF 10 FROM HOUSE
MAXIMUM LENGTH OFSINGLE FIELD- 602.
ALL CON . STRUGTION TO BE DONE IN AitrORAP
REVISED NY S. BULLET IN - 1, PART III, AND L
CODES.
BUILDER TO KEEP AREA FREE FROM CONSTRIJ
DESIGN 5 RATE BASED ON FILL I CIN 15 MIN.) r =6-
O 30" PERC TEST
7' DEEP TEST