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!�'•a>�.��iR.{c's�f?!; 3^;t ?,": h'S'�� ?w�+Vfrr ,r.r r.k �i s�'mae..r�a•E'{0 c'}.;a�r-r',._�. ,. .''+�...`.ra>= y'1r, -e>� Kam:
a ` y
t �j1
sr x
i
rCi
Ow r or Purchaser of building
;;;:. Constructed
oak
Locatio r
r
Building Type
Section
Block
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the location,
w orkmanship, 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 successors, heirs or assigns, to place in good operating condition r
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 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 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 operate was
caused by the willful or negligent act of. the occupant of t e building a i.zing the
system. /i J. /% n .
Dated this day of 19* Signat
Title .
if corporation, give name and address
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.
BACTERIOLOGY -.PAW T.OLO'GY , VIRO-LOGY - 4 "
-
- ANTIBIOTIC USED
•v y
SSOURCE:OF WATER IAL-4p
�REQUEST,p W239
;[]r800d-
{
❑,SMEAR. CULTURE Village Pharmacy Water tGS.t
❑
Putum
,-❑ Rout' e; -
Bill S'chreib6r
❑.
o :e.
❑ T.B. -
'. ❑•
roaf
❑ Diphtheria,
pine y w
Win dale, NY
❑fungus g
. ❑'
ece :_
°❑ ✓: 4%16.%74
us. rom -
❑
t er
❑: _
El
PUTNAM DIAGNOSTIC LABORATORIES
r;
p Ova and Parasites
-
'❑ Viral. tudies' °'... 10 STON'ELEIGH -AVENUE ', CARMEL;,N:`Y, .
_
C3 SENSITIVIT•Y
s.
es T.
STAPHLOCOCCUS.. ' :--7 p Aerobacter
orainphenieo
_ :,;
". '❑ Non.114 o.•Coag'Tofollow ❑ Corynebactenu, "•'- ,
`
o istin- u p ate ,. -" . -
; ,..�
'_❑ -,Remo yNc -Coeg ;To;Fo low a= :. ❑ Escheriehia'
ee omyein
7 07R-1-66simla,
"
i y - ►ostrePtomyci'`
x:
❑ ".= Negative ' ; -, ❑ :ParacoI_' Bact.,
ryt romycin > '` ;
s
R P . OCC S,.' HE, OL -❑ Proteu,
-,.
Nis m :cin'
❑ Alpha, Cl Beta ", '❑ Gaining: " Pseudomonas
`Nitrofura�toin :.
_ -
;.::-
❑ 'Enterococeus ' _ „ ,:: Entere Paehogens:.:.:
O_ xacillin - s
_` .0
p Pneuinococcus. ❑'xFound
_... .
ana 6 .:
; ^_
,.
❑ Neisseria ❑`,Not: Found_ y'
=
OHM_
❑ Hemophilia t.;
Tetraeye ins
TUBERCULOSIS SMEAR' ` . TUBERCULOSIS CULTURE'
riacety o can omycin
❑ cicl -Fast • Not Found, ❑ .Neg F.or Acid Fast
mpiu m.,,
„. °'
❑ Acid`:Fast - F.oun [3 os �.:
r
_7-
ears, Routine Neg. ❑ O P; Not Foun
Smears, s
ci u tu-res, - O osifive or -'
Coliform ` BaCi11i
'Less than 2 2 f
At the time of �examiriation wager was 'of good quality.
r
_
WELLI 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
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
NAME
Robert tilJeil
ADDRESS .
South Quaker Hill Rd Patterson,
T v
LOCATION
OF WELL
(No. & Street)
(Town)
(lot Number)
PROPOSED
"'USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT
PUBLIC
1-1 SUPP Y El INDUSTRIAL
❑ FARM
AIR
❑ CONDITIONING
❑ TEST WELL
(S(Specify)
DRILLING
EQUIPMENT
COMPRESSED
® ROTARY El A R PERCUSSION
CABLE
❑ PERCUSSION
❑ (Spe E y)
CASING
DETAILS
LENGTH (feet)
21 Ft; 0
DIAMETER (inches)
711
WEIGHT PER FOOT
26 Lbs o
® THREADED El WELDED
DRIVE SHOE
E YES ❑ NO
WAS CASING
®YES
�ROj TED?
LJ NO
TEST
HOURS
1:1 BAILED ❑ PUMPED ® COMPRESSED AIR
G.P.A.
YIELD (G.P.M.)
60
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
20 Ft e
DURING YIELD TEST fleet)'
Depth of Completed Well
in feet below Land surface: 220
Ft. _
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
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
t
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
12Z9/7 2
DATE OF REPORT
1 2/2$/73
WELL DRILLER (Signature)c
-i
WT, COUNTY -. DEPARTMENT OF H]
i Dfvis�on of 'Envifonmental Hea/tgh SefKIL; Carmel N
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Located at �— ' yr t✓ —�� n Section
Subdivision Lot
n
Owner �' ��� °�+ I 1 —�' Address
'.
Bg T
wid m ype `�►-- v"y Lot
Number ,of Bedrooms Total, Habda
Separate Sewerage`System:. to con§ist ofd ® Gal Septic Tank
To be constructed by Address
Water Supplylic Supply From
Private Supply to be drilled by
Address
Other Regwrements
T - ' represent that I am wholly and completely';responsible for the design and IocaUon ofI the proposed sj
atiove described will be corstructed'as shown on the Spproved amendment there to and :m accordance w�
County Department of 1lealth, `and that on completion thereof a Certrf�cate of Constructwn Comp.
be submitted to ahe Department and a wntten yguarantee ,will be %furnished the owner his Successor
place m,good operating condition any part of said sewage tlisposal system dunng the perwd of tvi
ance of the approval of the Certificate of: Construction Compliance of the or�ginal> system or any
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41 30� 1� = —= - =� 1700000 FEETI(N.Y.) 18 351 '1, A z rr . ,t +,.
0 0 l Ir 615 616 16 BREWSTER u.9 ,'l.
73 37 30
Mappedi edited, and published by the Geological Survey t
P
Control by USGS, USC &GS, and Connecticut Geodetic Survey 1000 0 1000 _
Topography by planetable surveys 1944 -1945. Revised 1958 MN...- GN t
Polyconic projection., 1927 North American datum C(
r, a _,; 1.,,< 4 ,,,, Mow Vnrk rnnrr(innta system.
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 N0. '51,211-63 j
Owner F,L.CA&t0V_ 06:14t_ Address PoiOY%,j 11tb—"�'&]. �,�,;
Located at (Street 6dicate �U 9LF1IF_1Z Vr.Sec. �� Block Z- Lot 3
nearest cross street)
Municipality O Watershed ceo-, 0V,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
No.
Start -Stop
apse
Time
Min.
Depth to Water
From Ground
Start
Inches
Water Level
Surface in .Inches
Stop Drop in
Inches Inches
Soil Rate
Min. /in drop
1: a C,.00,0
S
i Z
13 i
5/1
23`oo
4--
S/i
4 3 i3
5 3 : tca 3:Z1
1 Y2
1
3z
2
3
4
5
3
5
Notes: 1) Te 'sts to be repeated at same depth until approximatelyy 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.
DEPTH
G. L.
6"
12"
18"
24"
30"
36"
42"
48"
54"
60"
66"
72"
7811
84"
TEST PIT DATA REQUIRED TO BE_SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. HOLE NO.
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
Soil Rate Used t -L- L \'1Min/l "Drop: DESIGN S. D. Usable Area Provided S 6^X�1--0
No. of Bedrooms Septic Tank Capacity C, t "A Absorption Area Prov d By2� L.F.x24" ,, �w tY drench.
1A
Address
gnature
THIS SPACE FOR USE BY .HEALTH DEPARTPEM ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by
P ,
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property c
Located at
Date -10- o9-- -TQ,
Sectionl -M Block - Lot
Gentlemen: I 1
This letter is to authorize
a duly licensed professional engineer e/ 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 promulgatel by the Commissioner of the Putnam County
icj✓aittucitt of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of.said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
Very truly yours,
Signed
Owner o Property
Address
Telephone
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4 MIN.
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sn I c, TAii4K_
11 D E
va
CRIN I
CAST IRON
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-4 SECTION
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-r, i.
4
N 2
TYPICAL CONC.
PRE-CAST tONC.
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351.75`
m
- ---_-----
0
GRD; LEVEL
Z -
EA 1 11 311
ACPI1ILL
JOINT
A - A -,VLR
BLDG. PAPER
OR .1,1AY
PFRF "TED 5
4, TlIzo po FIE 6
isC. 1571r_ AW
0
PAPER
V
24"MIN, 36 CLEAN GRAVEL OR
CRUSHED STONE
ABSORPTION TRENCH
NOTES:
SYSTEM TO BE CONSTRUCTED IN WITH THE RULES AND
REGULATIONS OF THE _ ,
U COUNTY DEPARTMENT
OF HEALTH.
11 -ILLED UNTIL INSPECTED BY DESIGN
ri
SYSTEM SHALL NOT BE BACKF i, REQUIRED.
ENGINEER AND THE LOCAL HEALTH DEPARTMENT i.F
A 920 GALLON SEPTIC TANK
SYSTEM TO CONSIST &
S FT, TRENCH WITH A MAXIMUM
AND Z40 FT. 9V
PITCH OF 1/16', PER FOOT.
DISPOSAL SYSTEM GRADES REFERENCED TO FINISHED FIRST
FLOOR ELEVATION., UNLESS OTHERWISE NOTED.
ROVLC
LA�4APP
S.S.D. SYSTEM' FOR
rl A L. t- I so,' HOWARD A. KELLY, JR.
q<
A. K ASSOCIATES
No -DATE elf CARMEL .NEW YORK
0,21972 4
NOV
TAX MAP NO. S .13LK,.NO. LOT NO.
co-01 Ll" 1
TOWN OF
PUT," . ......... . .. OF
DIVISION
taw
N\,,R0NMEN_flll '"'v"EttVICEJ n &Y CI.A J, I Scot!Al. golLb—,
389,9 4 Chk C! Date 0,0wfmq No.
OF NE
Traced ApVd
FT
NHOLE COV
r
It
-00MV AD. LEVEL
JUNCTION BOX
4 MIN.
COAL.. r 4 1
sn I c, TAii4K_
11 D E
va
CRIN I
CAST IRON
SAN[
-4 SECTION
TARY TEE
-r, i.
4
N 2
TYPICAL CONC.
PRE-CAST tONC.
SEPTIC 'TANK 6INF. 8"C.C. D/W 1.
351.75`
m
- ---_-----
0
GRD; LEVEL
Z -
EA 1 11 311
ACPI1ILL
JOINT
A - A -,VLR
BLDG. PAPER
OR .1,1AY
PFRF "TED 5
4, TlIzo po FIE 6
isC. 1571r_ AW
0
PAPER
V
24"MIN, 36 CLEAN GRAVEL OR
CRUSHED STONE
ABSORPTION TRENCH
NOTES:
SYSTEM TO BE CONSTRUCTED IN WITH THE RULES AND
REGULATIONS OF THE _ ,
U COUNTY DEPARTMENT
OF HEALTH.
11 -ILLED UNTIL INSPECTED BY DESIGN
ri
SYSTEM SHALL NOT BE BACKF i, REQUIRED.
ENGINEER AND THE LOCAL HEALTH DEPARTMENT i.F
A 920 GALLON SEPTIC TANK
SYSTEM TO CONSIST &
S FT, TRENCH WITH A MAXIMUM
AND Z40 FT. 9V
PITCH OF 1/16', PER FOOT.
DISPOSAL SYSTEM GRADES REFERENCED TO FINISHED FIRST
FLOOR ELEVATION., UNLESS OTHERWISE NOTED.
ROVLC
LA�4APP
S.S.D. SYSTEM' FOR
rl A L. t- I so,' HOWARD A. KELLY, JR.
q<
A. K ASSOCIATES
No -DATE elf CARMEL .NEW YORK
0,21972 4
NOV
TAX MAP NO. S .13LK,.NO. LOT NO.
co-01 Ll" 1
TOWN OF
PUT," . ......... . .. OF
DIVISION
taw
N\,,R0NMEN_flll '"'v"EttVICEJ n &Y CI.A J, I Scot!Al. golLb—,
389,9 4 Chk C! Date 0,0wfmq No.
OF NE
Traced ApVd
FT