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'- PUTNAM ^COUNTY ?DEPARTMENT OF' "HEALTH
;.. r =
Division .of Environmental Health Services; Carmel N Y, 1.05'12 j
m-ft i -�F -Go del ¢t1j�°��tDE'�i r i,ovif��l�►i E FOR •-SE61iAGE.- DIoPd�4� S��ir� °,� j G�ws�� '�'r'.�:°'��i/�l �Gd"0 y
r
• z -� a � 'Town or Village .
iaxl"%R,
Located at �"L�'s�iiJ v //!'I /'T!/ �i�.d'✓ f 2 //yy
r IOCk G,
Lot JoG
Separate sewerage system - built. by "l`SSL Address'�T'4�
i >r -T7
Consisting of .Gal: septic`° Tank ''�ry lineal Feet :X width trench
Other, requirements
Water Supply: /Public Supply From
Private •Supply, Drilletl By
Address g
Building Type,..������ /fG , No of Bedrooms
Has Erosion Control Been Completed? ESSIO
1-certify that the system(') as listed serving the above pram' struct
attached) and,;in accordance,with the stand`a'r`ds;'.rules'a' V
Date r 7".'/ Cer J
'.'Address A. L
i4ny' person occupying preniises-served'by the above syste <� p rrip I � i
conditions resulting from such usage. Approval of 'the.
shown on
permit isa
available and the approval of the private; water .supply shall b, a tTilA vi hen a F
subject tolmodification ,or change when,` Jn �the';`judgment oft Rai Health
I
Date Permit 'Issued -
plans or he completed work (copies of ,which are
by, -. t Putnam County Department of Health:.
License No
s1may be-necessary to secure'the correction of any unsanitary
e. null and void. is soon as a public. sanitary sewer'becomes
lic ,water sup becomes available. Sucn approvals are
ch "revoca ' n, tlifica'Jon or •change is necessary.
Title
# 1719
VORKrOWM MEDICAL LABORATORY INC.
P e Box -99 321, Kear Street
Y Oa ktow n He I�hLs, N;Y. e059& - - . 245-32 03
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED
ROBERT J. TRISSLER
12/20/74
CITY, VILLAGE,.TOWN & /OR NAME OF SUPPLY DATE REPORTED
STEPHEN SMITH DRIVE, PUTNAM VALLEY., N.Y. 1V;/ /74'
$'AMPLING POINT
_
..W
BACTERIA PER ML. (Agar plate count at '350 C).
4
COLIFORM. GROUP .(Most probable N6. /100ml.)
LESS THAN 2.2
A9159ES -' ppm
6.0 GRAINS PER GAL. MED.HAR:
DETERGENTS - ppm
NITRATES (as N) -:ppm
IRON, TOTAL - ppm.
FLOURIDE (F) - mg. /1.
'These results - indicate that the water was c` of a satisfactory sanitary quality when the sample was c ed.
A. H. P.ADOVANI, M. T. ( SC )
D.G.
WF,LL 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 completed by well driller and submitted to County Health Department together with laboratory report of _
,• :-:• �:.=::: �:' iildl5ly�ls' Gf:' 1qf. 9tQ" iSa ;A?C3ip`OY2CiEus'6F'�§•W�'ec^r is 'rf= satisfactory'iiJC"�eerial �juaiet��efbre•ceriifi� ate of-bor tit•ucYion'c�►i�pj`r�rl�e`�s "issued:
RfPQRT MUST BE SUBMITTED' WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME Builder - Robert Trissler
ADDRESS
LOCATION
OF WELL
(No. 3 Sheet) (Town) (lot Number)
Putnam Valley, N.Y. 10
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
11 ROTARY ®A R PERCUSSION ❑ PERCUSSION OTHER
F-1 (Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
6 tt
WEIGHT PER FOOT
15
®THREADED ❑WELDED
5
YES NO
CA51N
YES
D?
U NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED ® COMPRESSED AIR
YIELD (G.P.M.)
G
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC(Spec /fy feetJ
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below Land surface: 0
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (loot)'
SLOY SIZE
DIAMETER (Inches)
EIFGRAVFEL
:
Diameter of well including
gravel pack (inches):
EL 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
--vt� 461—
1
If yield was tested of different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL C MPLET D
PATE OF REPORT
W XLL DRILL Sign ure)
U�l»tr oi� �Ibrc �)ase�).�oJ%build.ijlg t'kin.icipality
'r�°.•'•''"4"4 -�!°'�.rY,�..�.�°3' .•a� /tjJ �4'C.ti -� �• „Y3�'2�'�w:� �v:v�y;.:.:m,�. b•: �'vr•Nea %r .i!..__ar .'��: s�: '.�cK'Q .,• �a '+.,•.�,,;,'.I�.':'Q,w`, %..._.. .• � ��:: ,;,,1f�i. ;�,�. _• '., i�0 �_ • . w.rs �' .Pi'•o
' /� •' /
building Constructed by
a f�
Location - Street
o ..
r as
Building Type
Block
Lot
GUARANTY OF SEPARATE SIMAGE SYSTEM
I represent that I am wholly and completely responsible for the location,
.00rkmanship, material, construction and .drainage of the secrage disposal sysfem
serving the above described property, and that it has been 'c ons true ted as sho,,.n oil
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 successors, heirs or assigns, to place in good op-crating. condition
my part or said system constructed by me iehich fails to operate for a period of twb
,ears immediately following the date of initial use of the sewage disposal system, or
iny.repairs made by me to such system, except where the failure to operate properly
lti CaUbE'_U JJV LllE' willful Ur J1eg11�4t111. ac L of Che Ok iL:Upaii L ui uii: uLL11 - -J'6
-he inisi-cen
The undersigned further agrees to accept as conclusive the determination
�f the Director of the Division of Environmental Health Services of the Putnam County_
.) epartment- of .ricalth - as to : whether.-:'..ar- not the failure of -;the-:-.'system.-to .operate . was .
!aused by the willful or negligent act of the occupant of the building utilizing the
system. -
)ated this day of k ° 19 Signature
Title
(if corporation, give name and address
WREE (3) COPIES ARE REOUIRED WITH TIMEE (3) COPIES OF FINAL PLANS' BEFORE CERTIFICATE
IF COMPLETION WILL BE ISSUED.
UAWNTOR IS RFOUIR D TO. FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
• °
----------------------------------- s -------------------------------------------
ivision of Environmental Health Services, Putnam. County Department of liealth
• I
. 4
- = PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of . Environmental Health Services, Carmel,,. N. ` Y. 10512
CONSTRUCTION PERMIT: FOR. 'SEWAGE DISPOSAL SYSTEM
Subdivision TAr b�
,
Owner
r�
Building Type
Number of Bedrooms
Town or Village le-51 I
�L.J_,VQ .e'.��i�' ,p••tyi}r- .t, c+f•�PTt�:S�l�':;.: �- �_+i.. g- I�iCI(..^ �`C� :...�: .:�.'G e.
j8;f!�c`_'.��'..<Ol�- �` Lot / Job
AdtlressPw.,'_-
-2 2 j&9 Lj-» 0,6we, AL V,
,
� Lot Area � "71 '`,a
Total Habitable Space 1106-d— 1 6S Square Feet
I j �j af
Separate Sewerage System � consist of 8 -Z a Gal. Septic Tank N lineal feet X S -1 width trench
To be constructed by �iC f p� Address
Water Supply: Public St
Private S
Address
Other Requirements
I represent that 1 am wholly and completely responsible for the
above described will be constructed as shown on the approved
County Department of Health, and that on completion
be submitted to the Department, and a written guara
place in good operating condition any part of said I
ante of the approval of the Certificate of of
R
will be located as shown on the approved plan and that II
County Department of Health. �!
Date f �• "►,
Address "`ter• c-
APPROVED FOR CONSTRUCTION: This.approval expire
revocable for cause or may be amended or modified when cor
requires a ne� it. Approved ford osal of domestic
Date A/��F -- By —
of the proposed system(s); 1) that the separate sewage disposal_ system
in accordance with the standards, rules and regulations of the Putnam
struct,on Compliance" satisfactory to the Commissioner of Healthwill
,Vir, his successors, heirs or assigns by the builder, that said builder will
period of two (2) years immediately following thedate of the issu-
tem or any repairs thergto; 2) that the drilled well described above
nce with t& standarldf, rules and regu a� oil ns of the -Putrlani
the
P.E. R.A.
License No,
unless construction of the building has been undertaken add' -Is
missioner Health. Any change or alteration of con truction
Title
Gan , 1 e".-,, n :
Re:
Frope--t-- c' Asel �rzg
Looated Cat
Z)"ok"A
MI
XL E le, LANDER
SIA
Timis 1e e r _s o a o_ d5t,
a dul, e o e s
en;
0
co e c 2
s vs. 3 s S
11 T T- Z) - ", I i C jeD !.'1 1 , c ��7
E,*d,�,,.c EL t IT o r- J7. ., , J i-Z: L -1 � - - -- I , 45-he. Put,-n-ca--,r- Co---In tl-Y San i -
tart' Code. ..
Very You-r, 17
L 32--
ISTn 'T
O-,l
TC—,S
Date
74�
Gan , 1 e".-,, n :
Re:
Frope--t-- c' Asel �rzg
Looated Cat
Z)"ok"A
MI
XL E le, LANDER
SIA
Timis 1e e r _s o a o_ d5t,
a dul, e o e s
en;
0
co e c 2
s vs. 3 s S
11 T T- Z) - ", I i C jeD !.'1 1 , c ��7
E,*d,�,,.c EL t IT o r- J7. ., , J i-Z: L -1 � - - -- I , 45-he. Put,-n-ca--,r- Co---In tl-Y San i -
tart' Code. ..
Very You-r, 17
L 32--
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF EPMRONMENTAL HEALTH SERVICES
--• � T ) ot« .i. : � t_ t.:.�o:.,;�; �•� �f..`x.•` � -alt.. ar , tav •• .r ... ��T`
COUNTY OFFICE BUILDIPIG, CARPEL, N.-Y. 10512
DESIGN DATA-SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. ,/
Owner 0a g f �� >ss%. �° Address , a c ��' �/ �r�, 0x e, - /
/'�
_r4 Y. &fAP
Located at (Street � 1wit J�vrti E�ry _ 2 2- Block .6 Z Lot
�. Indicate neares cross s ree
Municipalit ; • Watershed /f5�,YsWwzz h'��'•� ��Y` %l 'oo, .
SOIL-PERCOLATION TEST DATA - REQUIRED TO BE SUBMITTED WITH APPLICATIONS
5
.5
2
3
4
01
do -fI-
Notes: 1) Tests to be repeated at same depth until a pproximately equal soil
rates: are obtained at each percolation. test hole. Ay1 data to e submitted
for review.
2), Depth measurements to be made from top of hole.
Ll
oe
Number CLOCK
TIFF
PERCOLATION
PERCOLATION
Run
Elapse
Depth to WdEer
Water Leve
No.
Time
'From Ground
Surface
in Inches
Soil Rate
Start -Stop
Mina
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
5
.5
2
3
4
01
do -fI-
Notes: 1) Tests to be repeated at same depth until a pproximately equal soil
rates: are obtained at each percolation. test hole. Ay1 data to e submitted
for review.
2), Depth measurements to be made from top of hole.
Ll
84" yam/
MICATE LEVEL AT VMCH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER EL RISES AFTER BEING ENCOUNTERED,
TESTS MADE BY ,lf��tt�� Date.
DESIGN /
Soil Rate Used Nin/l "Drop: S.D. Usable Area Provided ` 1, 4),
No. of Bedrooms Septic Tank Capacity % Gals. Type &e 6a-.F7'-
Absorption Area Provided By. L.F.x24f1 idth trench:
--
Other J [ ST
Address
THIS SPACE FOR USE BY FMALTH DEPAR j'T 7
Soil Rate. Approved Sq . Ft/
C 1;
Date
^~ a ' >,¢i — Ya. w eo- -o�.A• :.cy�. .�a,7. .. , . _'�T... 1.' .C: � w'F wit as y�+•..m. .a.. 1�`.a.:A • - cr_v cab _...1
i
TEST PIT DATA REQUIRED TO BE SUBMITTM WITH APPLICATION
DESCRIPTION OF'
SOILS ENCOUNTERED IN `i'.E.ST
HOLES
DEPTIi
HOLE NO. 61,
HOLE N0. f'
HOLE NO.
G.L.'��
. ,. %C �
,
1211�°1�
✓l�
1811
2411
,-,
�I,
3011
�:, X12 / ✓�,�
/�'- ��`'�c% �
�/)y
v, �_fw,e
3611
1, 211,
'4811
5411
0
.60"
g
66t1
7211
84" yam/
MICATE LEVEL AT VMCH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER EL RISES AFTER BEING ENCOUNTERED,
TESTS MADE BY ,lf��tt�� Date.
DESIGN /
Soil Rate Used Nin/l "Drop: S.D. Usable Area Provided ` 1, 4),
No. of Bedrooms Septic Tank Capacity % Gals. Type &e 6a-.F7'-
Absorption Area Provided By. L.F.x24f1 idth trench:
--
Other J [ ST
Address
THIS SPACE FOR USE BY FMALTH DEPAR j'T 7
Soil Rate. Approved Sq . Ft/
C 1;
Date
^~ a ' >,¢i — Ya. w eo- -o�.A• :.cy�. .�a,7. .. , . _'�T... 1.' .C: � w'F wit as y�+•..m. .a.. 1�`.a.:A • - cr_v cab _...1
i
PUTNAM COUNTY HEALTH DEPARTMENT
If 2 11 .a 1
DIkTISI0IY- OF EN�?IRONN1ENi'I�L ;I�A�T,...,SERV10ES
~ 225- 3838/225- 3833/225 -3641
:;_,. :..:,::.;:: - :: , ;::. �-::`` ~• : ,,.. - PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OWNER'S NAME
SITE LOCATIM
MAILING ADDRF
PERSON INTERN_
Name &
DATE
PROPOSED
(i.e, owner,tenant, etc.)
TYPE FACILITY
PHONE
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal -of proposal from licensed professional engineer or
Proposal approved Proposal Disapproved
pec 's Sig natur T tle Dat
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
C. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I jis owner o reported agent of own agree to the above conditions.
SIGNATURE - TITLE DATE
XIES: V&te (P H)); YeUoww (Tam BI); Pink (AVplicant)
-14
A
a: 35- C `
' .: .' ,, -• o � ,$ 3T3'. 3310"
j
4 dS
•,g
� �o °Jo •�'+�FaNStd>>t: Aim � _ �. .
r. .- w. .. .�.-.r �.., ._..� � . ♦ - •�. Iv•C". � _ _ S•t:. .•K .. .'^ '�i1ts. G W �G.W IiY - ., ».— m.a.,. w... �.. .w� .�
t$rrp spatem gas Cam as
,v j Q d nn this plan and tw tho syd
Wected by me before it was carp
— --'m A P P R V E T G The system was constructed UMCIM -. With all the rules and rq
bob .9 b Pam C mdv Dept.
JAN 1 19
A .. OF XEALTX
_ .Tire /lca11.aIww,7 hel-e --p , DIVISION OF• L HEALTH SERVICfi
o/r �a h•'7 /?�.SC^T/J�tlrr' /Ye o",''JS
5
h,
r i
I-VWV 0r= lr-VI- ,411,' Y4
:: ��rrelarl �v.✓ry� Y�