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' PUTNAM,COUNTY�`DEPARTMENT OF`:'HEALTH
Division of En✓ironmen'ta/ Health Services, Carth N. .Y.. 10512
T6i..n.�-.�'.CJ!?„"' ?t?C.��'�P�s�G°iltsL.A�t(,E CQ1.� SEVaA� -'6�F rv' T �PUtm r imy..(
Town or Village
122 2
7 y.LGLi ei S Vi: ®Vt 7 s '' t4+� - ..
;Located _ at M. Section Block
1 James Ziegler 10
G 'Owner • ,� Lot Job ,
Costa &Ferreira= 30 Villus Avenue New•2och ®llee NY
Separate Sewerage System built` by Address
s C Q _ r z � y
1
onsistg ,
p width trench
Other ;requirements `
None
Water Supply Public- Supply From 'r Y
X± Private Supply ,brilled `gy Anderson Well Drillers':
z _
Address • * • ee
Bar er:S reef Putnam Vall® Na �•
I Building Type .. Ranch v No of Bedroom; y� 'cQjfSE
1eS •',, �` �C� S �OT l •
, -Has Erosion Control Been Completed? = ` • ;O CFO e
vs.
� e
i� • 1 a
I cer,tify.-that the systems) as listed servi'n9 the above premises were constructed essehtially as shown ok lans let dggoQk (copies of which are
° attached) 'and in accordance' w`ith_tfie standards'',rules`and regulations plans filed; and .t e.permit is� y t C qyDepartmeht of Health;
A0 0
r Date
9401D O. 4197Z_ Certified bya ; rv;� �e1 • P.E. X ;R:A.
ArJtlress v l Northricl�e HOad eekskill� . NY ' �w �ICe ;e IVo.278L6
Any person occupying pramises!servetl by the above systems) shall promptly take such action as may be necessary'to secure the correction of any •unsanitary
r. conditions resulting from •such'- usage. .Approval of the separate „`sewerage sy ;tem shalt become null and void as "soon as ' a public sanitary sewer becomes
available and the -',- oval of the !private water supply shall become null and void when. a. public.- water. supply becomes available.. Such approvals are �
subject to modificat�on`:or cnange when, �h the ,judgment of the Commissioner'of Health, such revocation modification or change Is necessary. • %
.Date �c Q / gy �`�`
fir/ fir-
r
� ills
8196
YORKTOWN MEDICAL LABORATORY INC.
P.O. Box 99 321 Kear Street
Yark¢ow. tyhts N Y. tee". ro .... = -245 -3203
e- .a3SsEd SIIy..a,p iva gVJ./ti �9v
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED
ANN ZIEGLER 10/13/22
CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED
BARGER ST. PUTNAM VALLEY, N.Y. 10/16/72
POINT
TAP
BACTERIA PER ML. (Agar plate count at 350 C).
7
COLIFORM GROUP (Most probable No. /100ml.)
LESS THAN 2.2
HARDNESS, TOTAL - ppm
DETERGENTS-ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm
FLOURIDE (F) - mg. /1.
These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected.
A. H. PADOVANI, M. T. (ASCP)
James Ziegler Putnam Valley (T)
Owner or •Purchaser of Building I:`unicipality
:., -�4.; �.i.... .. �.. •?�i�::� � ��itir ��W. �.w �uw�= .Y'7►f,!.�,• e..v �'. +r N. mow.•►= .�.�i�.�.•rr�:4• i.P •Zis"':i �••�•vi►�i:..°.w�
�.�.. '.v `e vow -Y� .� o` +.:, 1.�'= r..�r•puw. •L.�. =:a :4• •°..0 i•�,•9"'.'�.'°°�s .
James Ziegler 122,
Building Constructed By
Barger Street
Location — Street
Ranch
Section — Ward
Block
Building Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
2
Kul
I represent that I am wholly.and completely responsible for the location,
workmanship, materials 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 Oster County.Department of Health,
and hereby guaranty to the owner, his successors, 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 completion 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 wilful or negligent act of the
occupant of the building utilizing the.system.'
The .undersigned. further agrees. to accept as conclusive the , determinati.on of
the Director of the Divisibn of Environmental Health Services of the BiC PUTNAM
County Department of Health as to whether or not the failure of the system to
operate was caused by the wilful or negligent act of the occupant of the building
utilizing the system.
Dated this 1 day of Sept 19 72
at New Rochelle, NY
Place & State
Signature
Title
If corporation, give name and
address)
FIVE (5) COPIES ARE REQUIRED WITH FIVE (5) COPIES OF FINAL PLANS, BEFORE
CERTIFICATE OF COMPLETION 6JILL BE ISSUED.
GUARANTOR IS REQUIRE TO FILE NOTICE • OF DATE OF FIRST USE OF SYSTEM
Division of Environmental Health Services, County Department of Health
..Putnam........
Fo- S.D. 50
•y it 1960
WELL COMPLETION REPORT
3/71 a-
PUTNAM COUNTY DEPARTMENT OF MALTH
a Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
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
NA
q
ADDRESS
LOCATION
OF WELL
(No. 8 Street) (Town) (Lot Number)
X/z
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ESTABLISHMENT FARM ❑ TEST WELL
' PUBLIC
❑ SUPPLY F1 INDUSTRIAL ❑ AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
El ROTARY AIR PERCUSSION ❑ PERCUSSION El O(Specify)
CASING
DETAILS
LENGTH (feet)
3 U r
DIAMETER (inches)
(0 rT
WEIGHT PER FOOT
f ® THREADED ❑ WELDED
DRIVE SHOE
® YES
❑ NO
n CASING (MUTED?
LJ YES NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED aCOMPRESSED AIR z2
YIELD (G.P. .)
f Y
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST teat)
j
Depth of Completed Well
in feet below Land surface:
S EN
SCRE
MAKE
'
LENGTH OPEN TO AQUIFER (feet)
REEK
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACK ED:
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
+
A) I
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE 7E L OMPLETE
DATE OF REPORT
WELL DRILLE ignature)/�
jr F, - HEALTH
-PUT
N F
e
0 N.,-. Y. 9051 .
_D1 n, o..,_nyw� e�/ CirMel,
!vis�qn, q..".
C6NSTRQQ.T1QN PERMIT FOR -SEWAGE -J,11 P Putn"1611PY (T)
-yr7ownn or ..Village
_..:Bir-gqr Strill
L
'k Job
None
Ji 10
Whit
Owner - ®. g er WROad,
James Ziegler` _'AdOrpss P -Bir
Putnam Y.
-A&eOi
an''CA"
R.
BU d L Are#,_
iling. type o
1900:
"T
Becir , oom s � Ldesign*ed, 6W'Hiba 16
of� sl� pice �Sq6are Feet
:S
k -3611
T fee • -2
5�6-0arafe §e��e—raje--§—Yst7e—mf =consist o-f Gal Septic ank. 40 :lineal. t x width trench
To Ott Ri fif-' 1146 tiegibn
be constructed 0
by�
ubk�'Sup, Peekskill j N.Y.'
1�at. -�.pp; P ply From-
Drillers
x
Private" 'Supply to be,drilled �bj..
.-,Othi . ar Requirements ..'Domedtid: Use Only
7
I -represent that I ' am wholly and completely responsible ior-toe. design .and !ocat* Of the pe?ppseq.'systj3T(s),` 1) that 'the separate sewage disposal system
sdibed will be as shown ?M4
;;above de wn on',the a pprov�d `� mend fiiiintJ648, b an pogiorFid 'with1hb standir s; r"leiand regulations U-7757-Mu =nam
aqe, u
artn� i_,of_�;HeaItI;i �and that -o reo I.0 0. On, Co p
' "County P n.,com'plklon-liid 9r. ic 69 &1 mpljaneell -satisfactoey to, the' Commissioner of Health will
be submitted to the, De r! guarantee will 21 ,P.isAucceisors, heirs or,assigns-by th6.15ullder,that said builder will
partmeht, and. a written -_.be �Ifw 1)
in.g6od oPeratinq-tonclitioii arty Pa of, said sevvaqe .'qispq$.p,1. d inZa, O� ;�cj-6f,.two (2) �Yeari im mediately follow Ing the date of the issu-
"of -,the . approval' bf,06. Cei.tificaie of Construction offip'li4p ri n re iri thereto; 2)'thai the drilled' well described above
ryctio n c c ,
cated ai•shbwn on t a[ rules and r
be;lo he approved plan and said - dw e; h e standards eguTaTions of the, 'Putnam
"County- Department of Health.'z
1972 x
Date --
g P. E. -;.-- R.A.
27846 )�_X
COUNTY
rgnM
DISPOSAL
ddress License
APPROVED FOR CONSTRUCTION: This "approval .impire cl�,- e S:s construction of the building has been., undertaken and is
one yea
,revocable oy,cause:or may be_amended or Modified when considerea-m- ic"ione-r'16i " F1,`l1ea_lth1.'1�.Any1!change or alteration of construction
c-s9anitay" ew, %ate,: �wa'fe 01' 'only.
req ores a new Permit. Approved for disposal of,domestl p
y
tA, Title
-4
F
j ', „� - _ .C�TNAM COUNTY UEPARTNN�IV+T HEALTH.
_ s
_ .. _, - •
iau�'• :.;t-•es. r� _ tr,b' - e= R'+v'�'�'�'�.- °Q°°!b �_%+��-- s- •. -ar..: ao" Y' ,_ °e ..
Q ,. � roT
r._ DICIJIG'�,' OF E2:VTfjL,N. PMNTAi HEALTH SEPVICES _
Y
DI March 30, 1972 --
Re: FropeH -y ^f James Ziegler
Barger Street
aG
;ti;.Y ' 2,T` Kin ck
fetter is to authorize
John S. Romeo
a &.ily licensed professional engineer x or registered architect
(ir:aicate) .
to apply for a Construction Permit for a separa`p sewerage system; to
serve the above noted property in accordance' with the"standards, rules
or regal? tions as promulgated by, the Coi- missioner of the Putnan County' w
Department` of Health,- and to sign all necessary papeirs .: on mny behalf 'In,.,:
"
r con�ectiom = i h t`�zs :�nattQr'.'�-li —tfj :.s tip ervi8e -. ��e constrta�t�or� Af sa$d,
- -
systen or systems i n .conformi,ty,�with the - provi'alons. -of Article :145 or°
147, Education Law, the-Public He alth.Law,'.-and.,thd, Putnam County" Sapii�.
tom_
Very truly y'yours,
Signed -
owner of o rty
i - White Birdh RoW Putnam, galleys NY-
Countersigned: J��'!J �'` Address
86x4 % - �o
P.E.', R.A. 9 # Y- r oa ®�s�ab.�� - .
4 "..� Telephone.
1 Northridge Road. q.
SS. fop N
Id dress 7 A4.
. ( /• " d x .y J` e
, .,t . t A, ' C
Pe® s�k J
`'.
f 3 R`wRr
7 = :1056 =9 ra • m_ ®� 4: :. 4 i ;, .:.
�. e. e p _one �oqR
.y
ti v y ti
a , r
t v k •..'t` �tor ,: ".r 't „x.-" r •; • 'YS�s _ 5.:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DNISION OF ENVI WIENTAJ, L ';�iJW7 - V.I:CBS, T;-
w ��7 H ':°S'; n.. ----mob C'�•.a- �� . -_ _ _ .. - _ _. � :��^0.~
COUNTY.OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Jam ®s ,Ziegler Address White Birch Road Putnam Valley.. NY
Barger Street lftyo
Located at ( Street 6-dicate Sec �
�Block � Lot
nearest cross street)
Municipality. Putnam Valley Watershed' Peekskill Hollowbrook
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
_ Number CLOCK TIME-, PERCOLATION PERCOLATION
Run Elapse Depth to Water a er L§vel
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1 4 :45 5:10 25 18.5 21.5 3.0 8.33
L
5:10 5:38
28 21.5
24.5
3.0
9.33
(2) 1
.4 :54 5:24.
30 17.5
20.5
3.0
10.0
2
5 :24 5:54
30 20.5
23.0
2.5
12.00
3
1
2
3
4
5
dotes: 1) Tests to be
rates are obtained at
for review.'
2) Depth measurements
repeated at same
each percolation
to be made
depth until approximately
test hole. All data to
from top of hole.
equal soil
be submitted
s;
36"
4211
48"
r4 It
J
6o ft
66"
72•11
7811
. -. _ ., _ ».- .4 —•�_ , -� .._ �. ...��'•.•�- ,`„r.. =�.q, ..a. �V. _�. Amt.. - :. .. .c .�� � �•C .... � .-.
_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. Larch 309 1972
DESIGN
Soil Rate Used Min/l "Drop: SoDo Usable Area Provided
No. of Bedrooms 3* Septic Tank Capacity 900 Gals. Type-
,Absorption Area Provided By LO L.F.x24" 3b V1 ;o:w fd reric
1.b ®droom house designed for 3 bedroom septic .r
Name o a Rom
o igna ure
n o xr
Address 1 Northridge Road SEAL
Peekskill fl N. Yo
m6
278 �
I. -THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved . Sq. Ft /CA10
0
f4' #f nil IP �
Checked by Date
•
a
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION
OF SOILS ENCOUNTERED IN TEST
HOLES
�.�.; -p; �:,:.K =� - .,::�,.• --. � -j= .. �r�: NO
e o
HOLE *
.G.Lo
Topsoil
Topsoil
Topsoil
6"
Toposil
62Toppsil
51P Topooil
12"
sandy loam, some clay
sandy loam, some clay
sandy loam., some' clay
18"
d� .
2411
grey sand
grey sand
grey sand.
30 11
36"
4211
48"
r4 It
J
6o ft
66"
72•11
7811
. -. _ ., _ ».- .4 —•�_ , -� .._ �. ...��'•.•�- ,`„r.. =�.q, ..a. �V. _�. Amt.. - :. .. .c .�� � �•C .... � .-.
_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. Larch 309 1972
DESIGN
Soil Rate Used Min/l "Drop: SoDo Usable Area Provided
No. of Bedrooms 3* Septic Tank Capacity 900 Gals. Type-
,Absorption Area Provided By LO L.F.x24" 3b V1 ;o:w fd reric
1.b ®droom house designed for 3 bedroom septic .r
Name o a Rom
o igna ure
n o xr
Address 1 Northridge Road SEAL
Peekskill fl N. Yo
m6
278 �
I. -THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved . Sq. Ft /CA10
0
f4' #f nil IP �
Checked by Date
"u
i
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