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631- 589 -8100
85.15 -2 -14
BOX 35
AN
04665
DIVISION O = NVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR'S
YE NO Internal Use Only PERMIT #
�tecac rer.-nit iss ir. ias: vears J 'D o* in
- •.. •� - • -• ' '•neaairvntntn 30� s.;nrr-�,rs "Vi-- 3ranct• c� ,.r2tor a' �e;s:�. ;� • °1��ai °d:
, •
_._. Reoair with 20C t of a watercourse or D =G-ma oe., wetiand Join: Review
-K--A
.. L 0 ,'.7 10r\ S8 .b._ .\ (1 TOWN I0,A^_..._ TM rr
--„_ _ -
'J�VN =r-. � iv.ylvi_ �p.. /��' �c:�r, cQ4 �-�ONL # cv'-{ uct<i -3z.(,(.
ai' INS �;DDR =55 �. u_\\ ted
Name aeaticnsntp (i.e., owner, tena conrractor)
=AGILITY TYRE PCHD COMPLAINT #
ROPO : =D INSTALLER �, „� ��-,� e:. --�� Le► L PHONE # 4 e,trLl -3 G 3
'
gJDR` =,J S� I,�rton� 1lL. �,a�.. 1�:y�.- REGIS T RATION /LICENS= Gl� G
=�roocsa, (include a separate 'sketch. locating the house, property fines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Depa,r<ment may require submittal of proposal from licensed professional depending on the
;;att.re and extent of the repair,
L.F>
as owner,aor o the conditions s ted on this form
SIGNATURE ! — L•- �.�',` ��' ---� -s T iTL ES���� DATE 1 Z -ci -G
(owner)
I, the septic installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE TiTLE DATE
(installer)
Pr000sal aooroved with the followino conditions: "' "" "' ' ' X "
Procurement of any Town Permit, if applicable.
Submission of as built repair sketch by the septic system installer within 30'days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
System repair to be performed in accordance with the above proposal and conditions
The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
I 7r) LF:&A 6Z Proposal Approved 9 Proposal Denied ❑
g,. / p — -------------
-
Inspector's Signature & Title Date Expiration Date
Repair proposal is in compliance with applicable codes Yes ❑ No 911
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
1 64 IN
AL
SEPT1', 'Ava
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: 4AA_(Z1C4)N:Q_A Address:" JA7DIAAj 6f //_/_ _-Lz0z6r
Located at (street): Section:8,6�-'B lock A- Lot f�
Municipality: P417A-1,4_m_,L1 ,4_ 1,L1_--V Watershed: /q
f
Date of Pre-soaking:
SOIL PERCOLATION TEST DATA
Witnessed by:,
Date of Percolation Test:
Hole No.
Run No.
Time
Start — Stop
Elapse Time
(min.)
Depth to water
from ground
surface (inches)
Start - Stop
Water level
drop in
inches
Percolation
Rate
min/inch
2
3
4
.5
1
2
4
5
2
3
4
5
2
3
4
5
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min for 1-30 min/inch, < 2 min for
31 -60 -60 min/inch). All data to be submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97, pg I of 2
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED. IN TEST HOLES
DEPTH HOLE NO_
G.L.
0.51
1.01
1.5'
2.0'
2.5'
3.0'
3.5'
4.0'
4.5'
5.0'
5.5'
6.0'
6.5'
7.0'
7.5'
8-0.
8.5'
9.01
10.01
HOLE NO
HOLE NO HOLE NO HOLE NO
e
Leo, A
0A
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: Date
7
Design Professional Name:
Address:
Signature:
Design Professional = Seal
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23
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FROM : ,GLOBAL CONSTRUCTION CO. L.L.C. PHONE NO. : 8456283378
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DIIVISION OF wNVIRONMSM7.AL HE 'i H ScRV1C F5
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PROPOSAL FOR EXPLOR _ZION OF SEEK SYSTEM FA►iL059
All information below must 13e AL111 completed prier to any scheduling � � � ^ � Y, 114
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13 Copyright 2004 Hagstrom Map Company, Inc. All rights reserved. No part of
WIC this work may be reproduced or transmitted In any form or by any means,
9 electronic or mechanical, including photocopying, recording•or by any
z (D information storage and retrieval system, without permission in writing from
132 the publisher.
The information shown on this map has been obtained from various
authoritative sources. Nevertheless, a work of this scope may contain some f
inaccuracies. Any errors and omissions called to our attention will be greatly F
appreciated. F
AREA SEE HAGSTROMS UPPER WESTCHESTER COUNTY POCKET MAP
v m�GRIDr
STREET s {„ GRID
ASTREETJ }I�GRIUt
STREET r GRID
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Forest iFibiest 6� A' I
14
jG*q0IctPr, �i
,
McManus Rd S N �4
South Bach HIIGRd Q r 7
'Ave Rd ?? \ Gc, Bs
�F -
,jj,
n Rd R
C -iiiR.:ii
kGortynke6MX,;.�;g.�.,
'Garland Rd`ftZ v )Rj
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;MomIjs!deiDqr�!.
Stage Coach Rd Q 3)
Istate.
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�State'Route -16
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Hanover Ro' s " R+ -4
Newaik,Fid R 4
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,Beverly Warren Rd :C t.7,•
Hi ;Old
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N�-
L74 f o x
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` f (. ..y 7• 7 1.77,
N? ENGINEER TO PROVIDE PERMIT #
P.UTNAM COUNTY .DEPARTMENT OF HEALTH
.ON.CERTIFiCATE F COMPLI CE,
\b Division of. Envirofimen[al N61th 'Services, Carmel N wY 10512 PERMIT # _
CONSTRUCTION PERMIT, FOR..SEWAGE DISPOSAL SYSTEM Putnam Valley
ow
F4. d ` &odStret 123 •Indian o Block' 1, ht 6 Located At Tax Ma P
Renewal, _ . _ Revision
.Subdivision ,�7,.. N/A Subd. Lot.H •N /A ❑
.owner /AddresRedhart Rlli l dersIP.(L Rox .216 - Mah Tar- •N Y- Date,Of Previous Approval
9�ildrn T pe 1 Famly-.Resdence�ot Area 2.598 ac. Pill Section Only ❑'
9'` y cL nn
Number of, Bedrooms,. 3 Design-Flow c /e /D _.-
...600-- Gpn -.•- - -•- P-.-C.,. H. D. Notification Required -
11000 500 L.,F. of 2! wide •trench
Separate Sewerage System to consist of 11 goo Septic Tank and
to Abe •deterrl.ned
To be constructed ' by - Address '
Water Supply: • Public Supply From
X Private SuPPIy to be drilled'bY to be determined
p Address C /
Other Requiremen 9
ts t deep curtain dram 21 R`O B fi11 (400 'C y.).3 CD. TO 916° EP4D tam
1 represent that 1`6m` wholly and completely •responsible for the desryn ind location of the proposed systems) 1) that-the separate sewage disposal system
.above described wi11•be constructed as,shown.on the-approved amendment there to and` in accordance °with the staridardi, rules an i regu a ions o e u nam
County Department of Health, ,and that on completion thereof a Certrlrcate, of Construction' Compliance" satisfactory fo the Commissioner oi.Healthwill
be submitted :16 the Department, and `a written guarantee -ill', be furnrstied the owner •his successors, heirs or, assigns by 'the builder, that said builder will
place in good operating. condition any ;part oi:'said sewage`dispossl system'duriny the per'iod;of two'(2f years immediately followipg,thedate of the issu-
once of the' approval of the Certificate 'of'..COnstruction, Comp san`ce of the original, system o► any repairs thereto;'2) that the drilled well described above
wilt be located as shown on the approved plan and that saitl well wtll'De-lnstalled in accorgance with the standards rules' and regu aa�TElons of 'the Putnam
sbUnty Department of Health.
j ot!i2L':�,�
Date ':Signed ., , . ,.. _ P.E. R.A.
Address.Cashin Associates: P..Gx;37 Fa t. Carmel N.Y. License No. 26008
APPROVED FOR. CONSTRUCTION: . This approval.exptres one yeararom4the'date ` is
revocable for cause or may be. amended; or modified when considered ;necessary by A,he
requires a new permit. - Approved for. disposal_ of domestic.' rotary sawn e, 'a /or
Date -AM
it7 gy tom....
1
.Rev. 6/85 .. _..... .
ue nlecs construction of the building has been undertaken and Is
Commissioner of• Health. Any change or alteration of construction
irivate water.suDD1Y only. � h
Title
M
PUTNAM COUNTY DEPARTMENT OF HEALTH
•r
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�l. �� 1� .� � � c. ., t. b R • J N...v - �. Y 4:p _ v:;`.�win �Q., �;�. w .•� _•�.'� 4n. c^ bj'��I. .a•'NfL��Y•e-�.. .ir:i -'� �� cb..L Y �. —,�
Date `��t , l
Re: Property of 96DHART 5 u u >EQ-5
Located at R?.L.c_ _U - _� �cx�►7 SZ'. - \-
(T) -zt, &M \/ALLEY Section 12.3 Block / Lot �o
Subdivision of 11/A
Subdvo Lot # IN /A Filed Map # Date
Gentlemen:
This letter is to authorize c-m-�vk1KA A!:sn < -tATCs P-C-,
a duly licensed professional engineer or registered architect
(Indicate
to apply for a 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
connection with this matter and to supervise the construction of said
sy�t rri. —$ -in, provisions. .0
147, Educati
tary Code.
Countersigne
W—), R.A. , # ?-&OCR
37 rAitz
Address..
Telephone.
Public Health Law, and the Putnam County Sani-
>� ` A eery truly * yours ,
GC d
i "'
ESN 0 er of Pro erty
Address
Fa 3 K z/ C=l
Telephone
f FUZ.L S= INSPECTION at
II In_smectel v
` t CWOER Z' �-✓ c, •-lam
_ s � _ " v< a � l.•! '" I'� i OR Su4ItT''SI
C7,-s area locat= —Q as
b. Fi> SaCti.ca - Dot=
2:1 ''rietr .
C-
1yGrY -G_L : Q-
d.
Sire,
bra
e_
100 ft
f-a
II. S DISC ? -L
a.
-g=-z '-c
tank
b.
S_ct c:
ta-_k
C.
e_
f.
a_
h,
10'
I dllina -M f_an fc�: rc-Licn I
No
90o hands, will in 10 fz. Cl C50
d P'= eas i lV ac=eEs i ole iralm- of e to craee I
I I
5. First. bex
6. Cycle w-, `na --San by F-=.-al-`h Desar cent-
DISLtc Tj TTCN ECIX
],•,
p CLt__:5 at l.c E_eTTC_C._ We =ar t�.t=--;
I
2.
Prat==es= bF- 0, __cst (
I
,j. r�:1�21L311 L. ice. L.�1�!�_��. rVl� Y.._nC�_ l.t. " "l1 C�:L' L_— ••_�L•:1�5 � ✓
2. Di stanc =_ to WG -a--c .=,ze
3. liL -.1 1 _.r aC ter;._' n.c7 to plan I ' i
a Dlsi�?7ce can tar to ceriger -7, I I I �
5. Slcrz of t=orch etcent=_ble 1/15 - 1/32
6. 10 fear i =^ lirCTe--7% 1? rie - 20 f--- - rcun.z-C1cP_5 _
8. Roan
9. Size
FL'T CR EOSE SYSI--7m-S
3. ldzx , vises 1 /eu-rio I
I I
d P'= eas i lV ac=eEs i ole iralm- of e to craee I
I I
5. First. bex
6. Cycle w-, `na --San by F-=.-al-`h Desar cent-
1_C.7n L••CL L-0- - - 1 ' 1 / I
IV. FOU,5E - I
a_ 6.cL2 1cc.t--.: LE_'' a urGV-ed plans.
b. Na._er cf bF corn_= I
V- VEIL
a. well 1cc- -t d as r'•c--- 2- CrCVc1 ola^5
b. Distance fran EDS ar= Tce s lre-,-' ft. I I I
c. C_sinc; 18" ahcve trace_ I I I
G. Surface G'_P -Cc crcund Well accentrable- I I
4i. GVE..azT u WOPj LwaS"r---Cl
a- ECxes rCCrIV c-- cut= ---; 1
b. P11 vices pa=tialliv bZCkf-iller Jx I
c_ P1l Pines f1t,<z wit-i i^sice of bcx I I
c_ Eack:i11 irate_riE? ccnt=i.ns stcr_es < C" in ciG:_te_r
e. Ca ;,•a; n d= ; n actor-4-inc to pL*i
f. 0-2=-Lain drain CLt-f;::1I T:rcte` t- & G1;.to
EY? 5�- _Wc:�rCCL?r52
C. cctinc drai is G, cv.GV fret c�'S c=c
i. ="Csica C P_ --Oi CrCv1C- CL1 siCCes C_� = L' a_ r t -1 1�3 . I
I I
DAVID 0. BRUEN
County Executive
Mr. Richard Zapp,
Cashin Associates
Fair Street
Carmel, NY 10512
Dear Mr. Zapp:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
February 11, 1986
JOHN SIMMONS, M.D.
Deputy Commissioner
Re: Redhart.Builders SDS Construction Permit
Indian Hill Road, PV, TM 123 -1 -6
This Division is in receipt of revised plans dated 3 February
1986 for the above referenced application in response to items
communicated 23 January 1986 in the form of a checklist. Your
attention is directed to the "Program Review and Policies....for
Single Family Residences" which has previously been forwarded to
your office and specifies regulations governing sewage disposal
permit submission. Appendices contained therein will clarify which
details are lacking or incomplete; additionally, fill volume and
spe =cifications- are lacking.
Upon receipt of revised plans addressing the above items,
review will continue. If there are any questions please call me at
225 - 3838 -or 225 -3833.
JSH : a�nm
cc: File
Very truly yours,
James S. Hodgens
Assistant Public Health Engineer
TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
W
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
DATE REVIEWED:
LOOT--
nation)
DOCUMENTS_
Permit Application
Corporate.Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profit - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trekh %Gallery; t details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located.
Representative of Sewage & Expansion Area
Expansion Area;shown;gravity flow,suff. size
_If _Pumped Pit & D Box Shown & Detailed
'Ise -No;;,- :: -No of- Bad. amens = _
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
.,..� .._._.:.,,�q� ^� �_:�,,- o�- w....;.�__.�. _a- ro z. -�= Lc,'�.'g- .:,4 --- s� ... - .. ,'_ -•' n � 'r- ��"=_:=�,:'_..:.�. = c...:v= �- '-�= YtsA:�s -:::i'
°�s' '..4 -r1.. i •!i.Iy cx� a I r r s r c l sa R'7Aa .:
-
a
r Y �` IX
f •'' r U sly . ' 1`{(1i'1 CD 1 1 .' Draiii[<LMEN OF HEALTH ,
DIVISIt7N :OF MrMUNERTAL HEALTH .SERVICES
t-
sr
DFSIGN DATP� S� �Sr.TBS�r�: ��vP! F.Q RST EM .....
�_� Ownex;'.c�1�,42T CrL�ER� Address (��. ZDx �-(�
Lecated,'at (Street ),.. :Wt o6,p S,— Sec-'123 Block I Lot
(indicate nearest . cross street)
pTA U Watershed M,un cipality C ►'�-T�
SOIL PII2CC)I,i�moo_TESI'..DATA '� TO HE . S[JEi�ffTI'ED WITS APPLfCAZZONS
3:
Date of Pre = Soaking ►'2 1 ,5 Date of Percolation Test / /• S'
HOLE
NU-mm CLOCK mm A PERCOLATION`^'• PERCOLATION
Run
Elapse
Depth to. Water Fran
Water Lever
5 .
No
,'Tune
Ground Surface
In Inches
Soil Rate
Start- Stop.''Mifi.
I -Y8 2 Z
Start Stop
Drop In
Min/In Drop
Inches Inches
Inches
4-
18 /Z
I /3Z Z9
2 120 :
30
7j
17 le,
MlN�
3 6Zp - 2 zo
CD I % ly,
422 -Zg-1
I�Y111
I �q
5 .
11ZS9- 1z9 30
17
3
I -Y8 2 Z
4-
18 /Z
I /3Z Z9
MlN�
..
.1 r
- -
40 `
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 fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED.. TO BE SUBMITTED•WITH APPLICATION
. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
G.L.
a
10'
11'
12'
13
140
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
� 1
INDICATE.LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 2.
DEEP HOLE OBSERVATIONS MADE BY : J Z DATE: I2 5
DESIGN
Soil Rate Used Z1 -30 Min /1" Drop: S.D. Usable Area Provided 50CXD '
No. of Bedrocros 3 Septic Tank Capacity /CdoC7 gals. Type M
Absorption Area Provided By _'50 CD L.F. x 24" width trench
Other. ' E G 2TA i N t7RAt ti! 2 2.0. �'1 Le . ° `7: E�
R _
NameLAS"to AS5ex l RC Signature hf,
Address. 3'7 F►rz SEAL
CARMEL - Iv.l . 10,5f Z OFNO: 2604 p�
rHE sj P
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by _ _ Date
4�'
TdP�tt
WaT
2'
sA�c?Y
3'
LoA
WIC.d-AY
4'
a
10'
11'
12'
13
140
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
� 1
INDICATE.LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 2.
DEEP HOLE OBSERVATIONS MADE BY : J Z DATE: I2 5
DESIGN
Soil Rate Used Z1 -30 Min /1" Drop: S.D. Usable Area Provided 50CXD '
No. of Bedrocros 3 Septic Tank Capacity /CdoC7 gals. Type M
Absorption Area Provided By _'50 CD L.F. x 24" width trench
Other. ' E G 2TA i N t7RAt ti! 2 2.0. �'1 Le . ° `7: E�
R _
NameLAS"to AS5ex l RC Signature hf,
Address. 3'7 F►rz SEAL
CARMEL - Iv.l . 10,5f Z OFNO: 2604 p�
rHE sj P
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by _ _ Date
4�'
7r 2
PUTNAR
ACOUNTY DEPARTMENT
1
RP-V. - h3186 vie" \�. / 1/\ Division ofknmental HiW'
Ser
d:d e'.
oer
0 F, "I UL-jawc* L"CE.
lit
'GE
To*n or V.."4
Road anti Uxb68. is Tax Lot
IA
Q*ner/app can Me�nrid Pime dlW eTs V.1rb6dy. SubdIvIsIon'N'dime- ' v Lot qN
A
''' Rip
Mailing Address 1P.O. ::461
bflt byPjprAbd1r+ Rni 3 Inc., Address P FAX "Q16 Nq-LO641
SeO,"te Sewera SY"stexn
ge
Cbnslitlng 0 ' f
Gallon Septle Tank and
water su,pp!y:. I*M'Supply From Address
-V4"-jr% 15 as PO COX �411 AY_ Kjwy 10 04
PrIvaiti Supo.ly. D�rffled by
V 8ns '. Addre mon
Bufidl I n Type Has rosign Control Been Completed? ICS
_9
Number of Bedrooms Has Gm6sje Grldder Been Installed?
Other Requirements
i certify that the,-.system(s) as listed serving the above essentially asehown.or the,plang4of the completed work copies
of which ale attached)", and in accordance with the standards, kuies"ind'rqgplati6As, in accordance-with the filed an, and the permit issued by the
Putnam County Deoirltmeht; Of, Health.
Date Certifled,b PA R.A.
License No.
Address
upying prerni action to secure.the correction of any unsanitary
Any person occ ses served by the above necessary
and 'void as soon as a pubtl: sanitary Ower becomes
cond ns resulting frorn- such -u'sags., - Apprcwil'oi the separate -sevwirs"�� -she
available and the approval of the private watei'supply shall bacqrm"a nup4pa '4o when's Publk,.: water supply becomes available. Such approvals are
h Up M
subject to rnoclificatioin' or change when, in the judgment of the C Mi su *Callon, n odifiritlon or chinos Is necessary.
Title
B
ki. y
r f
V
Cn
: (Main 'Lab)':
LAB.:.OFFLCE .HOURS'
9AM` -5PM; Mon .,4 ri
12 /85(Rvsd7 /f.7)RWE 9AM- NOON, Sat.
jj Mk-004062
,�.
Yorktown iVledical - �,aboratory, Inca LAB B
° d.
- - -
321 Kear Street e l $ A ;
Date Taken .' b _��� Time
Yorktown Heights N. Y. 10598
Date Ac" d _g Time . x.30
914f2.i'`�;, "iteported
r .. = • -.�,�, .. ::= V77
Directorz Albert H. Padova»i M T (ASCPf
., .., . '.'.Collected
o
By:. .D :.:Torlish
T -� _Referred By:
`1
Sam ,
Location:. 7-ek l�C- ►.pT a3-�1
'- „TORLISH &'SONS
b
PO Box 271'
Armonk, NY 10504. Phone
Ph oh
J
�
Sample. Type.
Repeat
Test? _'
(check ,one)
Potable
,.LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY
OF WATER
_ Non = potable
STP.INF
STP EFF
GENERAL1BACTERIA
Other:'
Standard Plate Count (CFU /1.OmL) d
(Agar Plate @ 3.5 °C.)
Sample.'Status:
(check each)
MEMBRANE` FILTRATION TECHNIQUE (MFT)
Outgoing
:K.Tota.l.C.oliform (CFU /100mL)
_ 2 2 3
Fecal Coliform (CFU /100mL)
incoming' ,.
Fecal St re (CFU /100mL); -
:.
LE 4 °C
:MOST•- PROBABLE NUMBER TECHNIQUE (MPN)
_
_ GT 4°C
Other:,
Total Coliform:- MPN Index (per, 100mL)
_
e al ��a�i: o. m. ;NFI�...:.I:n.dji,,x_ -(pe -r 1�:1"aiL')_�
OTF1vF” p c�iLYSES
KEY. FOR TERtdINOLOGY
=
RDS•,....Recommend'Disin fec-
tion of Source .
TNTC= .Too ;numerous To Count
RE.4 - S ( Fcr gab ratory -. Use)
-
CON =. Confluent ( =TNTC )
- --
LT.: = Less Than (< )
' - -GT ..._ Greater Than ( > )
N /A ,= Not Applicable
LE" 'Le-ss than or eoual to
: (Main 'Lab)':
LAB.:.OFFLCE .HOURS'
9AM` -5PM; Mon .,4 ri
12 /85(Rvsd7 /f.7)RWE 9AM- NOON, Sat.
0
F,.0 T- NAM.SXli1L�7_L'Y
it i.:r -s � pair. = T.:- 'aC•�•,w,•'�-.'ti%'.,�y.;., a ..4 9'' 4 ° _ - - -��x '� ^'.�". t7- o'...•..�:: ,�'.� ;n"��.i: - ,'Vt?'-::
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�ed har+ '.ui IriPrs
Owner or Purchaser of Building
awned
Building Constructed by
1 nC'a an 1-W Epad and Wmd S cee�
Location - Street
�-�r�m Valley .
Municipality
I F l denCe
Building
tia3 �
Section Block Lot
'Subdivision Name
Subdivision
Lot #'
GUARANIEE OF SUBSURFACE-SEWAGE DISPOSAL SYSTEM`
I represent that I am wholly and- completely respdnsible 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 guarantee to the owner, his successors, heirs or assigns, to. place in good
4
operating, condition, any part -_of, said system constructed, by. -me which_ fail$ toy:.,
o�xahe�- fvir- a-fpei ied •6 -two -years i-�mediately- °follcxa�lg the date of approval of the
"Certificate of Construction Compliance" for 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 occupant of the.building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health. Services of the Putnam County
Department of Health as to whether or not the failure of the system.to'cperate was
caused by the willful or negligent act of the occupant of the building utilizing
the system. .'
Dated this �r day of �. 19 Signature
Title ��G�i2i Cc,✓,� ,� `�
General Contractor (Owner) - Signature /2� �� /� ,12114yff'S -z'c.
Corporation Name (if Corp.)
Corporation Name (if Corp..) p�% oX /�
Address
Address
rev. 9/85
mk
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL MTER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
d X
FIELD INSPECTION REPORT
\
DATE:
� � • -�
�"�'' _........0 :...,. `7 .. _ XNSP.. •. BY,:
• t .... i-- .e.r�.. -c.� .. �R'a :].:. .... •:yp ;f•..p�...r' .T �, �•a-aa :. s : -.. ...; lL� a.L �%i �.r4. -x es .y��Y��. � :.S'Y >n•:�. sM etn�''~�.» .. :..yi _..:,.•
INITIAL SITE INSPECTION 2T 12, - F YES I NO CCM ENTS
Property lines or corners found ...................
Can estimate house location .......................
Will driveway,need cut ........... ..................
Must trees be removed - note these ................
Deep hole representative of- entire SDS area........
Additional deep holes needed ......................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
`rte
D. H. 1 Lot D. H. 2 Lot
Depth to G. W. �_ Depth to G.W.
Depth to rock Depth to rock
Soil Descri
0 ft.
-7-�) t C(�,
3 ft.
.6 ft.
9 ft.
12 ft.
FINAL SITE INSPECTION
boil uescrl ti.on
0 ft.
3 ft. /
6 ft.
9 ft.
12 ft.
INSP.BY: YES NO
House SSDS located per approved plan .........:...
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roam allowed for expansion trenches ..............
Over 100 ft. from swamp, watercourse .............
Natural soil not stripped or SDS area
unnecessarly graded ...... ......................
10 ft. maintained from property line and
20 ft. from house ..............................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench.. ...........
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set ............................. ...
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot-drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE ..................
rev /9/85
IZ(-(9 (2)
D. H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
boll Descrl tlon
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
COMMENTS
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+ : UR-Tarty ` A�ty DR
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:...
1,000 GAL.
42
; SEPTIC TANK
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