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04651
PUTNAM COUNTY DEPARTMENT :OF .HEALTH
c
Dfvisfon of EnvfronmentaY Health' Services, Carmel, N Y 10512
••�3it. i kvadse: + 3f STR'UC'ilC ! C fV l.Illd r0R SrdYtiGE liJFO SAL T,
r A/ VA L,6
Town or V,nlal
Located :at Ca r * Tax Map f 22ff 81ock}
Owner • u Lot
b
SeParate`Sewerage SYSteuilt.tiY`UVi+= OIrJCv:Ca'P { Address!►04j7E hN° 4.KD'1� /F'.BW'1k�PRG
-- _ in
Consisting of t0: GaI. SepticTank 4ani! '�/=
Other requirements �`
4
Water Supply-' 'Public supply Fr m
/ o I�
,
. e
�Private,supplY` Drilled ,By S�
L�
7
-1Jr' �L c.
AddressP sr dff
.
Buildin9APe A06) M_, o: N of Bedrooms Date Pamp�(ti3e�Q� H LTH
TY
1-1as Erbsion`Control Been Completed?
WWI
I.certifyy that the'system(s) as fisted serving t ises we ed assent( I es 'shown of
attached); and in-accordance with the st -the permit is
Date G.' +� wv� led .Y /
Add
Any person occupytng.premi ; es ierved bye gyp, m(s ly take such action as may
conditions resulting from such.: usage A' pr, �7 g ge,system:shilPbecome nul
. available and the approval of the pnvate: water �INLW` e I and hen a +public' M
subject =to modification -or change when, in the'; ommis, ner ;H Ith 'such- I
x r`
BY
a ®v
16��x�44
the pia of the completed work.(copies of which are
d b .the Putnam' ,County •Department,•of Health.
A. E. R.A.
License
be necessary to secure the co rection. of any unsanitary
and void .as on_as a;•publie. sanitary sewfir•.Deeome><
ter: ppPI ;t ones available. Such approvals are
rocafion, , ifs tion or change is necessary.
1 Title �
.r✓.. .- ..... ... .. .. .r _♦f.. �;.. .r ate. -•.ql. ♦ . � -Y .. _ v +� ... r r ✓.. �� .•w• .. ... .. w. ..ice `.. .�W' +..r. ♦..y ... r...�.� V r..
Ca
KiY
YORKTOWN MEDICAL LABORATORY INC.
P.O. Box 99 321 Kear Street —
Yorktown _
.Yorktown Heights, N.Y. X0598 � :�;....; ; ;. ° . � �. , � � . y, ... } r -.. , 245 =3203
#11913
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED
Ba &Vo Builders 12/4/78
CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED
RT. 6 N RFD#7 Mahopao9 N.Y. 12/6/78
SAMPLING POINT
Well @ Barger Street9 Lot #12
BACTERIA PER ML. (Agar plate count at 35 C).
8
COLIFORM GROUP (Most probable No. /100m1.)
0 MFT
HARDNESS, TOTAL - ppm
DETERGENTS- WL
NITRATES (as N) - Mg /L
IRON, TOTAL - Mg /L
AMF9vvla o &,Kzz t as N W mg /L
These results indicate that the water was " ;,,° of a satisfactory sanitary qu ity when the sample was collected.
i
F T �� � 1�4� d H A. H. PADOVANI, M. T. ASCP)
Vjg & M t9 .4TION PEPORT'l TNAM C9
VNTV MfflITURAT Of "$a
kTH
Division of rinvironmentAl Hoolih Opivko
t
CPUNTY OFFIC4 PUIL.DINQ • CAfl114, 10gW YORK
th. Op amm ta9a!her.V
Part- 11 t n ty.. H. e j� par�m
- TWA �J@ E91* F-Q mglf Itt AIMWIPAPM. -01
f
q#!hpre ihdjW1h1q�'^W At jg'�;f4iis& y
iar"I �aierial quality t)e ore certificate o construction P9
Ong@ III IRM,
REPORT MUST 13E SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
-7=0*77
"(Va. A
LOCAICON (Torn)
-7 !9 LJ FARM TOOT W9
FSTA11103"MIENT
PIJUIC AIR OTHeR
INDUSTRIAL.
§UPP16Y r.PNDITIP"INQ
COMPRESSED CAME OTHER
ROTARY' AIR PERCUSSION PERCUSSION (Spoclf�)
EQUIP V
CASI I NO, !4MIT 11(inc.hoa) Miotff fee FOOT Rmg smg�-- XMI-11
_Y
LA mo
Y93
0 Sa'T"119ADIED
Mom G.P.M. YIULD
TaIll §AIM COMPRESSED AIR
PLIMPE4
WATER *114§4411 IFROA AND 30 !ACE-511 PURINO YIELD TEST f!041)
Depth of Conipletad Woll
in foot Wow Land siW'rfq.C'Q:1.`/,FV
LE
iAlgtl MATE! (InchFa)
Ism Ilin Mzz (Ipcoo
TQ (IF
IF GRAVEL Piametax of wall Including
PACKEDs tiravql pack (Ino'h04):
01M FC014 LAND 6 MACE
Sketch exact location of wall with 4latatim.. 00 fl wil
ATIQN DESCRIPTION two pormanqnt landoorka,
FEET 1FENT
R R
-e
7.
If
0 lit 11 du
If ifeld W0 1604'21 -die (a —00 409,41illing'. Iji,
PERT GALLONS- '8 .1818'
PER MINUTE
PUTNAM Wi
P J.:. Q. E - H
V.,
Pool,
QF( PEPQR7 WE L.
Owner or Fur c aser o f Building Munici— pality
V F-UJi -Dt0 (; CORP-
Building Constructed by
�aP, G 6 0= !4.66;r
Location - Street
R, F_51 P01-r-AJ —[ I A i
Building Type
l
R I AZ MAP
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 :Wade by me to such system, except where the failure
to.oper.ate 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-
.vices -.of -; the" ,0ta ;n9r __Cc)un±� . Zecal• .jl U rf Health -a.s -to TrihP.t;.izer or. '_got 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 thi s _ day of c:_ 19 Signature jfG'
Title ICE
7-If corporation give name
and address)
r
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
t 1 t.-.
DE
pC ; NA'6VI, GOWN I Y.
VC -T, QF .HEALTH
"All certifications hereon are valid for the map and copies
thereof only if said map or conies bear the impressed
seal of the surveyor whose signature appears hereon."
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QffFRAP*MEM a'v®FM <P O cSC�7L�
SURVEYED & PREPARED BY
ALEXANDER BUNNEY
LAND SURVEYOR. P.C.
20 WOODSBRIDGE ROAD . ROUTE 117
KATONAH. NEW YORK 10536
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B�POUGNT TO OATS` � OCT 4, /9 � ��,•` �� I � !t '; ,� 1`
St [DEC
�j PUTNAM COUNTY
o EFT. OF. HEALTH
"It is hereby certified that this survey was prepared rJ"�
in accordance with the esistinq Code of Practice
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'{ �` ' ` �` x M PIJTNA'M °COJNTYk- DEPA "RTIIIENT�'OF HEALTH��
4' �� . ; r w
'> ` Ofv�sion of Enwronmental Health` Services Carmel N `Y 10512
�CONSTR,UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM dr!^J � r -4
Lticatod at' chap / ' Block;
Subdivision Loth 7 Job
Owner v /�D /�1 CG Address L�pd F
Building Type -� L Lo,t Area
Number of Bedrooms o_� Design Flow `� O ° pp Total - Habitable Space,. Square Feet },
parate'Sewerage ;System'.to cohsist f _4 ��� eri ,' ,Gal Septic Tank antl OD J ar ` � tl±C,
L- l /Of
ToN be constructed `by _ir; a /�� /I�iLo �c�i%� Address'_
Water supply. Public Supply From v
Private :Supply to be drilled by
T Address 1 r
Other Requirements t
I represent'that I am wholly,, and completely,.res e�le tion R_ dhe proposed systems) 1) that the, separate sewage disposal system
•above describetl will be constructed as shown.o to and in accordance with. the standards; rules an 'regu a ons o , e . Putnam
County ;C+epartmen.t of Health, _a d that on, i Ce of` Construction_'Compliance" satisfactory.to the:CommlWoner,of'Healthwill.
be ;submitted to "the Department, and a wr uar urni a owner his successors, heirsor'assigns' by the builtler; that said builder will
place in'.good; operating- condition any part f id: sy unng the period of two.(2) yearsimmediately following the date of the issu-
ance of the a royal of the `Certrficate :of ucti: of he i anal system ar4any repairs thereto.; 2 that the `drJled.:;well described ;above"
PP 9 ),'
` w,Ul be- located -as shown on the approved plan' t' nst lard accordance .with the ngards, rules and: regu a ions 'of the. Putriam
County Depe`rtme°nt of- �fH,rea /lth _
Oate P.E. R A. f
° Atldr @ss License No 3L7�
APPROVED FOR CONSTRUCTION -, This approval expires: ear from t he. date issued unless. construction of .the _building has.;been undertaken and As
vepocable'for cause -or may ?be amended:or•inodifie' when conside ed necessary: by the Com in ner of Health.' Any change .or alteration of-construction
requves a `new ermit Approved :for disposal of'atlomestic`;sa ita wage, ;and/ °priv, t , water supplyionly:
PDate By t
i t ,
I
FIELD CHElCK LIS`r.
7 7 ��
. ..- .`�' -,. "- �r "�'v:.,.. C.: ../ '�•.. .'�v-l•.�� -•^.•` . ... ._ ..... �. .r?4i ~3.�Ga�'iT �i rC�.��� :mac'; .�•'af.�:7",l'� ti" Z�.� .. �/`:e .. ...... �- .:`�T:�:
INITIAL SITE INSPECTION
Yes •
.No
Comments
,Property line; or corners found . .`a . C U Y .
v
Can estimate house location . . ... . o o .
_
Will driveway need cut
[L' --
Must trees be removed-note these
Is deep hole representative of entire SDS area
Additional deep holes needed. . . . . . > .
Sufficient SDS area available considering
driveway cut,house location, separation .
distances etc. . o . .
DEEP HOLE DATA
Depth: i �Y
Water elevation:
.Rock elevation:
Soils descri.,ption: cy l5-
e.
FINAL SITE INSPECT10�N Insp. by
House located where 'shovn on approved plan
SDS located where approved
Longth of trench measured
Width of trench average
Slope of the line and trench. acceptable
Room allowed for expansion trenches
:.
—
Over-50. ft. from-, sT,aamp,- wat e rc ours e . _ . a. ..y.'•
IVatiiral � soil not - stripped or SDS�area
iuuiecessarily graded
10 Ft. maintained from prop.line and
20 ft. from house
Sep"Irati.on of trench from house, well
etc. follows plan .
hrumber of bedrooms checks . . . < < . . .
Stones, brush.' stumps, rubble, etc: greater
than 15 ft. from nearest trench . . . . . .
_
15 Ft. of peripheral soil horizontally from
trench
Junction boxes properly set
Cou-Id surface run off from driveway, roads,
ground surface, etc. channel near SDS
area . . . . C . . . . .
_.
Does lot drainage appelar 0. K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE
}
REVIEW C1I(:'CK- SI- ET
IMe ets
Std . Remarks
es
No
DOCUITENTS
` _ :.z�; .�. - .C.. .. .. - r ... as • -%.v. ^ ". ,mow'' eat': ^a 9R a. -� � : ni <.� , .... n .. . . -.
house plans 0. K.
Design data sheet
+
Peres presoaked?
1;--in. 30" ' perc test depth_
Const. results for 3 runs
D. Hole log 0. K.
Corporate Affidavit for other than individual
�.
Authorization for engineer
Witter from Water Supply if, applicable
if variance requested -such noted.on plans &apps.:
DETAILS
if change is proposed,)
fshow
Existing contours shown new contours)
Slopes for driveway cuts, etc: shown
1Zater service line location
Footing drain, etc. location
ToIj slope, bottom slope of fill
Percolation tests and deep test pit location
✓
'
Seutic tank size and conformance to std.
B.R. house minimum
souse setback shown
j
Distribution box ftg. below frost,
Lt
.All water water within 50 ft. - of PL shown
.
Plan and profile SDS
All other wells and SDS closer 200' i I
shown-or,-.reference -.made,.
2'roper'ty' boundaries (metes and bounds - clearly
show
SEPARATION DISTANCES SPECIFIED ON PLAN
4
I
10 to P.L.
'
t f
/
t
201* to Foundation walls
r
-00' to Nearest well
00' to stream, march, lake, etc. incl . expansion
; r .
15' to Curtain drain
10' to water line (pits-201)
15' to storm drain
� t�
10' • to large trees
10' from foundation to septic tank
5' to pipe frow leader drain & .foo -tng Erain
✓
• PUTNAM COUNTY DEPARTMENT
DIVISION OF VIRON�IENTAL..H:
OF IiEALTH.
_'AL If SEIWIC�:.a..-
Date -2' -�
Re: Property of B V Rav-0106
Located at
err 'iA : Block Lot j
Gentlemen:
This letter is to authorize_ STANLEY I LANDER
a duly licensed professional engineer or registered architect
(Indicate)'
to apply for a Construction Permit for a separate sewerage system; to
serve 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
. slcns of hrticlI� or
-system .or systems-..in- conf ormity wi;th; -the
14 7, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
P.E., °9 #--_-3-z22-
STANLEY:1. LA DE
Addres ,' 7
AMA ALL, N. Y. 10501
.245-2.645
ephone
( Seal
truly yours,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner0 V by►LDjjj & C__0 PP. Address Ro O-I-E ( (J. RFp w-7 EA+4,o PXc . A 1A �/.
Located at ( Street &g6 E%L. ���° � 2 Block `2 Lot
n Ica e nearest cross s ree
Municipality ' OLLW OF PTt►Ah Watershed��e_cr_si. it,', fb LL o 6-J
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number' CLOCK TIME PERCOLATION PERCOLATION
apse 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
PI l 9:1 -21 i 174 ��4 3 4 -3
2 9= 3o X1:44 14- 2i 73
4
5
FZ/ 1
1- ... -o._. �. _....,... ay ._ ... � .. .... . � s .,c ,.f- .t.�.�__..:... � .eel •. .. --,. .._ .....e..,.,... ..,,j ....P - -. r .. .. e ...s � `��
4
5
3
4
5
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.
"_. ,,.,(�l_i.'i�t,t•.I) .]'fail ;I IC�I,.�,,
1Jr.'l'7'II lIOLi h0. f POLL 1\0. I1O1,1, fJO. v
E.L. oso�G %'175�Lops�l f
1ph
211 i� J/ �✓ d 1a1�
30-11
J'" _
6011
66"
72„ - --
A
INDICATE T 1 C L AT l,TETC 1 G inl.' 1, 1,,., EI . is Tn " T,TD IV 47
Tills 1"2,.DE, BY ` TIE -T ii T,•r .-,. T.� -`_E -�. � 1',�, r rte• '�T,1 /}nT'•1.•il' - -. • /G /frG,�s
II�DI.L�` �� L 'J; L i 0 tllCii ,�r '� 1 it _� v� S 1' T i,_Pj r>
rp
�L 'R_�S�. �: �I,_ tau L,,,...�.
Da
Dis3IGfl --
Soil Rath sc j.,..A 1t?Jy.,d:b .; ; . Tay
mri'Cli
No. of Eyodroo»:s Septa c T nl: Capacity Gals. TyJ�oi�
.Absorption Area Provided £�,�' G L. F'. x2�; " :/ ju'-. Width tren—h.. --
- Otber
Address lopl
THIS SPACE I'OF USL BY I1� �L.PI1 DPI Alrl Jji.•,
o.sa'�2�`�
80i1 Fate Approved Sq. r't. /Cal. Date
a
w
All certifications hereon are valid for the map and copies
thereof only if said map or copies bear the impressed
seal of the sury yor whose signature appears hereon."
Q�
Al
f i7 /_ ° 5' S" A /7' G
,:Pa'7 /T'
sB9 °OO " /o "E
r i 22
JULY /7 /970 AS /J'/H!� .N.° //88•
i
i�
wOT TN /S PROPERTY sTAKE-O ? ' LSUR V� O/ /RO��RT/ OUT
1:
//V
,Uvlit���l coUivly ' ;•
NEW yDRK •'i
OgJ E= /NFY 25, /97G Q7OR E-M
SURVEYED & PREPARED BY �Ja
ALEXANDER. BUNNEY
LAND SURVEYOR. P.C. l ,
20 WOODSBRIDGE ROAD ROUTE 117
KATONAH. NEW YORK 10536
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ALEXANDER. BUNNEY
LAND SURVEYOR. P.C. l ,
20 WOODSBRIDGE ROAD ROUTE 117
KATONAH. NEW YORK 10536
�. �SU�4 ✓EYED Fe�F7. /NANVE� 1�iq�.QL%E Z "It is hereby certified that this survey was prepared
ff in accordance with the existing Code of Practice {�
n `t' FL�Rt, /•. /T //1 %� BAG c /F?O�/ for Land Surveys adopted by the New York State
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