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01302
3. PUTNAM COUNTY DEPARTMENT - `OF HEALTH
' Division of Environmental_Health Services, - Camel, N. Y 10512
Y _ ;CERTIFICATE .O.F+ CCWS,TAUCTION ,COMP. AWE. ,F „OFD. SEWAGE DISPOSAL SYSTEM• ,
Town
- or Village
Located at Section . Block
Owner Lot- Job
,.Separate' Sewerage System built -.by ����� r Address
Consisting'•of Gal. Sepfic.T'nk '5, lineal Feet X � U width trench
Other rekiW ments ”
Water Supply: Public Supply,From - _
Private Supply Drilled By
Address:.
`Building Type No of Bedrooms Date Permit Issued
.. �
Has Erosion Control Been Completed Ye S ?
I certify that the systems) aslisted•serving the above premises were constructetl essential) shown on the plans the completed work (copies of which are
attached), and in accordance with the .standards, rules and regulations'p(ans filed', _permit is he P am County Depart ment�of ealth.
)Date' Y ertified b P.E. R.A.
i Address License No
- Any.'per.son •occupying._premises served .by the abo e= system(s)- shall;, promptly takesuch action as may be necessaryto secure the correction' of any unsanitary
condit ions. resulting from such usage.. Approval of. the separate sewerage systerfi shall become null and void as soon as a public sanitary sewer -becomes
available.and the approval of the .private water supply shall- become null and void when a,- public .water supply becomes available. Such approvals are
su61 .tt to modification or—change when, in the. judgment of 4he, Commissioner of Health; such :revocation modification or change As necessary.
BY Title. V .
yiK,sZ•.v
0
WELL COf\ OLETION 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 �
NA A
ADD ES
Q
ELL 1 S A. TA R LT O N LABORATORY
CONSULTING SANITARY ENGINEERS
CHEMISTS & BACTERIOLOGISTS
34 PLEASANT STREET
G/ S 0 A-.#,/ /
DANBURY, CONN. 06 10
203-748 -7903
REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER
According to Standard Methods of American Public Health Association
NAME AND r .J Builders ,Source of Sample
ADDRESS OF Builders S � �j�a,tek supply,
PERSON TO t, pre,ston place t Putnam Lake
RECEIVE Warwick Road Patterson, New York
REPORT
L_ New Fairfield, Connecticut 06810
Date of Collection January. 8, 1975 COLLECTED BY H �
Data
Hydrogen ion h
(P)
COLOR
TURBIDITY
ODOR
Dissolved Solids
Concentration
6 *4
1i/
0
O
Wane
2700
0000
Alkalinity as CoCO3
56.
FLUORIDE (F) M
Nitrite
Mg /L
Bicarbonate
Mg /L
000
Mg /L
•80
Nitrate o
Mg /L
Alkalinity as CaCO3
Carbonate
0
Mg /L
Sodlum` �Na) 21 02
M
NITROGEN
CONSTITUENTS
g/L
O^
*OW
Total Hardness
140
AS
NITROGEN (N)
Ammonia
Mg /L
as C00O3
Mg /L
Mg /L
.aom
Albuminoid
Mg /L
Iron as Fe
• -50 Mg /L
Mg /L
Chlorides as CL 756 r
J
Mg /L
i't00
Manganese as Mn
Mg /L
Mg /L
00
26.)
Detergent as ASS
Mg /L
Sulfate as SO4
Mg /l
Mg /L
The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST
one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50ml, 4/100ml, 7/200.1, or 13/500.1 Coliform Colonies /100M1
in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c)
More than five per cent of the samples when 20 or more are examined per month. 0
1. The results of the analysis of this sample are satisfactory and meet requirements for a potable water.
2. The results of the analysis of this sample are satisfactory for a potable water but certain of the chemical or physical constituents are high. These
areres followsHigh chlorides.When sodium is above 20mg /l persons on low
salt diet should be warned* Also Iron.
3. This sample is not satisfactory since it does not meet the bacteria requirements or a pota le water. The presence of organisms of the coliform
group in a sample of potable water is undesirable and, while not necessarily indicating the presence of any disease - producing organisms, does
indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the
treatment was not adequate at the time the sample was collected.
El 4.
This sample is unsatisfactory as a potable water because certain chemical or physical constituents are above acceptable limits. These are as fol-
lows: Hard, highly mineralised water, acid, with excellent appearance
COMMENTS and good sanitary chemical history except chlorides. Rate
of corrosion is above normal.
i
• ertifie �.- .,...«r -...
o:
c:a° vr. `lhr;:lia:: •I Of build:i.a1b fka�s:i •lt,C� ily .
ldll;d (.anst acted Ly Section • a _ .
b
a.tion Strc t Block .
o'
ldil:� 7ype - Lot • . - � ..
GUARAN TY OP SEPARATE SYS' "E'I
b
1 represent that.I am wholly..•and conipletely responsible for the lcc�ltion,
kmanshin, material, construction and,.. E.'rainage of the. sewage . disposal sys i•em .
✓iiip the 'above. c}eseribed property, and that it has been constructed _as sh_b-. n oil
�approvcd . plan or approved a!,?E-nd-m ent._ thereto, arid. in acco d. nce lli. L l th" .standarr'S.
2s. and regulations' of the, Putnam County' De. rtmer.t of HeaTt}�, and hereby. '�uarant,.
C }ie: a�rer, .his successors, Heirs or assigns,, to place in ocod opera:tn� cor:�ii:Lio:�.
p.prt of sail system.constructeu by me- which fails to .opera�e for a �erio "u of �.:o
^s: inl.mediately follc:,ino the date. of, initial use of the sewa?e discosal -s, step. or..
.repairs mad vy me. to -such system, except vhere. the failure to' operate- pro;ierlv.. .
zaubd'_U.U"; .6le W ill 1U1 U]L' IIem-11,4'tllL ctl L 0j the ouu-iNail� V1 'L441 ✓LA— +.wr.8b Ni....�..�..d
VE
The undersigned further agrees . to accept as conclusi�.�e t}Ze clUtermi.rlation
he Director of the Division of Envir,bn.,enta1 Health Services of the Patriam Ccull;
irtr ent of Health as to vhether or not the failure of the' svStem, to 'opul r site was
ed Dy the c�illiul or negligent act of the occupant of the building utiliziro. }le
id this �� day of JL 9 Signature
Title 9711i
( corp a.tio, o11r namae and aui res:
:E (3) COPIES • ARE RF:GUIPED ►•?ITH THREE (3) COPIES OF FI \AL 'PLANS B RE CERTIFI.C��'lE
- OMPLETION I-JILL BE ISSUED,
zl \1'oR T.S RF01.11RFD 'O- FILE NOTICE OF RATE OF FIRST USE OF SYSTE`i:
• ..s - - --- - - -- - -- -- -o - e - d--------- .- -------- -- - - -- -- - - -- -- - -- - ---
:s3on of. Ern ►irolirnental . Health .Services, Putnam. County. . Depbrtinent of Health'
., ..
vie- NA
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JAN -1
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q _ �UTNA�GUU,V f r/u t '0 Uil
MVIRQNMENTAE HEALTH SERYIf�
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f6.F° 4sdRF ll�
To I
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iT
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-
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e •�w•�„'., a�. _tom- �, i {{• 70
Y LL
�: %' - +. .. : 1' ..;.f . i 3. ' '. >,. - +_.: «. -�,�. _ _.,�_.:,:..< .r....a.��....,.S.L �..,�,.z:' ✓..a -. ",: "v.s�'.....,��af..{,._ _.._x_ ... _. � . k.._....�r�".5..;. �.. _.. _.t.: _ , �,
Dws�on of Environmental N
6OWRUCYION -PERMIT FOR- SEWAGE DISPOSAL SYSYE
- Located` at ,
- Subdivision
Owner- -
i
Building, ype - Lot Area
o.
:'Number of Bedrooms
•Separate Sewerage.`System to consist •of. -. 025 Gal
r
Tc bii constructed by
j
Water Supply Public 'Supply From
^ Private Supply to be drilled by
Address
i 'Other Requirements
:I represent that 1 am wholly and completely responsible for, the design and
above:descrrbed wil1.be;c9p. ruc4ed ass hown on tlie_approved amendment't
Count a "f'
y D pa.. menu o Health, °,,and that on complefion thereof a +;Certif,
tie-
submitted ".to the'De arfinent nit: a r
p a w itten''':guarantee will'be "furni
..place, in good 'operating' condition an p ar t of said 'sewage disposal sy
ancp of, the. approval of. the Certrfiwte of Construction. Compliance of
will be located as'shown on the approved plan and that said well will be inst,
County Department of He Ith
_ r
Aam-'& F P
x ,,
j-APPROVED FOR CONSTRUCTION Thisapprb4al expires one yearfrori
,,revocable for ca`u'se or-may be amended or,modifieii, when considerednece!
requires a -new permit. _Approved for disposal of domestic sanitary se
y
Mat e1
iii
a.a.v ua u�c w,ur ano aam waru r e
a ui a aria uracro a r L am
r
eey or >;ne n u n
of Construction Compliance •satisfactory to the Commrssioner.of Healthwill
the owner his successors heirs or assigns by the bwlder that said builder will
during the-period-'of .:two „(2) +yearg imm''ediately;3following the date of the issu
o'r' al system or any repairs thereto _2) that the drilled, well.described. above
accordance wi the st dards,`rutes and' °regula i�`ons of;.ahe }Putnam
I
date issued :unless constructio f the building h-at been undertaken rand is
by'fhe Commissioner of'Health.- A ny 'change;'ora er'atiort of constr ction* .�
and /or private water' supply. only \ a {
R_ENIZVT CHECK SI=T
DQ UMENTS
House plans 0. K.
Design data sheet
Peres presoaked?
Min. 30" pert test depth
Const . results for 3 runs
D. Hole lo; 0. K.
Corporate Affidavit for other
Authorization for en'gi.neer
.Letter from Water Supply if a
If variance requested -.such no-
ca ole
on plans
dual
apps.
Meets Std.l Remarks
Yes No
Z
/
DETAILS
if change is,proposed,)
Existing contours shown show new contours) ✓
Slopes for driveway cuts, etc. shown
Water service line location
Footing drain, etc. location I
Top slope, bottom slope of fill ! __
Percolation tests and deep test pit location I
Septic tank size and conformance to.std.
3 B.R. house minimum ! I
House setback shown !
i-u..1 1Ja 1�Uf' Y11 l i E1 11 ,V l 'ui rL OLivwli
Plan and profile SDS
All other wells and SDS closer. 200'
shoirn . or reference mace _
Prop✓rty boundaries (metes and bounds - clearly shoes'` i
SEPARATION DISTANCE& SPECIFIED ON PLAN
10' to
20' to Foundation walls
100' to Nearest well
50' to stream, march, lake, etc. Incl. expansion --r--
15' to Curtain drain i
10' to water line (pits -20' )
15' to storm drain
10' to large trees _
�0' from foundation to septic tank
15' to pipe from leader drain & footing drain.
1 ,
I r
• e ° o ,e
o Datr'.:
o
I1,11 'T1! L SITE IP-SSPr?CT.iO;,T o
Yes
No
,
Cce :r. r..nts •
PrG` crt;�' li, nes or corner fo•,"id ° o a o a a 0 ,
,,;•i`1 estiIhate house local —ion ° ° , o 0 0 0 o
Will c?ri veuay nee? . cut ° a a e. 0 a a a, a 0 0
bust .trees be rernoved -note these a a e •e 0 a a
Is deep hole rc%presentative of entire SDS area
f
01.7 er SC., f °t. frcm si•ram -o Eer'covrse
—Natural soil not st -ipped or SDS area
i lly graded e o 0 0. 0 0 0 a
10 A. tra.inta.ir_ed from ° lino an
r' ",� -
_
Separation of trench fron house, Drell
Additiotryal de--D 'Holes needed. ° ° ° e °' e a a a
dumber of bedrooms checks e a o a o 0 a o a a a
Sufficient SDS ai yea available consideri:_�;
/f
Ys�tu.?:ps,
than 15 ft. from 2'1e —SL trench o 0 o o o o
J
driveway cut, house location,.separation e a e
•distances,
_
trench ° ° e 0 , 0 0 0 0 o a 0 0 0 0- 0 • 0 0 0 a
'
etc. a O -o ° p 0 , a 0. o a a a a
Could surface run oi•f. from drivevay, roads,
J
groand surface, etc.o channel near SDS a • e
_
DEEP 110 =,, P.tTA
. 0 0 0
Does lot dr? in3ge atitiear 0. K. in area of SDS
Depth: 7 "-
Water elevation: D
Rock elevation: � •.
Soils description:
Date: �.
FINAL SITE 'IDSPECTIO ?'I Inspe by
.
House located where shown on. approved plank o . a
— - _ _ • ... 4 % - -
- f
M as •e• .•_ v •r•;,e. •- ..• v. • • .... • V V •.i N' i V Y i,..til' • e . -• e o e a a
r "R'�"��l'Ct"f frC:d�ciP"E� - fi"��' ,.c'
- .
•• �.
Width of trench av -ra -c 3
Slope of til.e line and trench acceptable e ,
Room allowed for expansion trenches a a a 0 0
✓ _
01.7 er SC., f °t. frcm si•ram -o Eer'covrse
—Natural soil not st -ipped or SDS area
i lly graded e o 0 0. 0 0 0 a
10 A. tra.inta.ir_ed from ° lino an
_Drop
20 ft. from house ° ° ° , a a o 0 a
_
Separation of trench fron house, Drell
etco follows plan ° e o 0 0 0 0 0 0 0 a o 0 a
dumber of bedrooms checks e a o a o 0 a o a a a
Stones. brus �, nubble, e tc e ore2.ter
/f
Ys�tu.?:ps,
than 15 ft. from 2'1e —SL trench o 0 o o o o
J
1-5 Ft. of peripheral soil horizontally from
_
trench ° ° e 0 , 0 0 0 0 o a 0 0 0 0- 0 • 0 0 0 a
'
Junction boxes prope_Ply set
Could surface run oi•f. from drivevay, roads,
groand surface, etc.o channel near SDS a • e
area o o a o O o o o o a 0 0 0 0 o 0 a
. 0 0 0
Does lot dr? in3ge atitiear 0. K. in area of SDS
PMU GRADING OF SITE ACCEPTABLE,
0
a
• o
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES s.
COUNTY OFFICE BUILDING, CARMEL, N.Y. 105121'
0512 1
t
t
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Address
J
at (Street ����� T�ee� Block���
Locat .�.._....
indicate neares t cross s r e Al
Municipality AA�a27 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITT pWITH._APPI;ICATI.ONS
Hole V
Number CLOCK TIME PERCOLATION PERCOLATION.
Run Elapse Depth to Water a erg vex
No. Time From Ground Surface in Inches-.`' Soil Rate
Start -Stop Min. Start Stop Drop lin "':Min./in drop
Inches Inches Inches
14.6 S
2 4'2E- 4.3� /7 'r, 2S 7, 2
11
3
4
5
tl.
Notes: 1) Teets to be repeated at same depth until apppproximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.
G.L.
/V
611
1211
1811
2411
3011
3611
42"
4811
5411
60"
6611
72t1
7811
8411
INDICATE LEVEL AT
INDICATE LEVEL TO
TESTS ,WE BY v 7
HOLE NO. HOLE NO.
" W .-.7 C-) - .- I - DESIGN , - - - - - - - - .0 .1 1
Soil Rate Used Dbn/l"Drop: S.D. Usable Area Prov1ded
No. of Bedrooms Septic Tank Capacity 90-0 Gals. Type
Absorption Area Proms L.F.x24 3 X width trench.
A A 9C A)
Address
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved
Sq. Ft/Gal.
Checked by
Q
NJ
"v � %
------ i'lu
e; w .
WOA16
WH!(CH
GROUND WATER
IS ENCOUNTERED
V
�ICH
WATE�F LEVEL
RISES AFTER
BEING ENCOUNTERED
V. -'4- ffd.
—Date
" W .-.7 C-) - .- I - DESIGN , - - - - - - - - .0 .1 1
Soil Rate Used Dbn/l"Drop: S.D. Usable Area Prov1ded
No. of Bedrooms Septic Tank Capacity 90-0 Gals. Type
Absorption Area Proms L.F.x24 3 X width trench.
A A 9C A)
Address
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved
Sq. Ft/Gal.
Checked by
Q
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
D t o to' /�, /9�
P1 C' o -�, + r\
Re : Property of. John Petri 11 o s ca VV
Located at C -oJeS 00' %,Vc PO+nc, m Lc, Ke e o,^�
Pj L 1' 4 Section Block Lot /
Gentlemen:
This letter is to authorize George A. Haughney
a duly licensed professional engineer X 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
�:VIIIAL. LiUI1 wl�rl �Idb maLLev anLi to. supervise iine construe-ciun of said
system or systems in conformity with the provisions of Article 145 or
1.47, Education Law Public Health Law, and the Putnam County Sani-
tary Code.
OF
S.......
pRTHpgygGpiO�
Counters ignea•c�/� K
Very truly yours,
Signed
P.E., R.A.,
Carmel, New York 10512
(914) 225 -9353
Telephone
Telephone
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