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PUTNAM COUNTY DEPARTMENT OF HEALTH; PROVIDE
Division . of, Environmental - Hee/th Sermps, Caren% N. Y. _ 10512 P E R M.I T # ..
CERTIFICATE OF.:CONSTRU ION COMPLIANCE..FOR ,SEWAGE DISPOSAL_`SYSTEM PATT^RSc�a
�-f Town' ei'- v�ilale
.- �• ^�-
�` Owner Imo° lOty'1 �siP• / Formerly Tax 'Map LoY q r a fig` Subd. ,Lot H 3
MoUEIL_ �� ?.1l GoR�. RT:. Z9Z h�o� -Mrs' 1J�/ hZ.581
Separate Sewerage System. built by Address �
Consisting of 1 GC0 Gal. Septic Tank and 3'15 L ;:F.'...A:BSo C+ A a
Other requirements
Water Supply: Public Supply From
x Private Supply Drilled By VAQ'44.0;
Address
Building Type 1��SCDEfJGE `'
Has Erosion Control Been Completed? 7 ES
Vi L--To N . C:'T, 0(0891
140. of Bedrooms 3 Date Permit Issued i
Has garbage grinder been installed? JJ0
I certify_"at the system(s) as listed serving the above premises were,constructed essentially as shown on the plans of the completed work ( copies
of which are,attached),.and in accordance with the standards, rules and regulations, in accordanca with the filed plan, and the permit issued by the
Putnam County Department.Of Health.
Date Seri, a) certified by _ — ' PA. R.A.
Address PTE $Z CQnE� l License No.
Any person occupying premises served by the above system(s) shall Promptly,takasuch action as may necessary to secure.the correction of any unsanitary
conditions resulting from such .usage. Approval of the separate•sewerage system shall become' null and void as soon as a public Sanitary sewer becomes
available and the approvat of the private water supply shah become "null; and void when a public water supply beCOmsa available. Such approvals are
subject ttoo modification or change .when, in the judgment of the .Comnlli inner of Wealth, such revocation,, modification or change is necessary,
Date si .� ���
Rev. 6/85
PiPTNAM COUN`T'Y DEPART OF HEALTH
DIVISIO!i
Owner or Purchas of Building
Aga
Building Constru by
Location - Street
icipality
Building
%&
Section Block Lot
M,M_ ERMCNe"
- . _ I L I 0;)W�_
Subdivision Lot #
GUARANME OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represents 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 guarantee to the owner,. his successors, heirs, or assigns, to place .in. good
operating condition any part.of'said system. constructed by me Wh'idh'f ails, to
- -- operatte for- a period- of -two years immediately following .-the. -date. of approval . of the
"Certificate of Construction CompY"iance"'"`for"�tYie'" sewage- dis�sosal "-s}�sten;:yor...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 operate was :.
caused by the willful or negligent act of the occupant of'.the building utilizing
the system.
Dated this ')-7 day of 19 Signature
/ Title
neral tractor Owner) -/ ignature � l
Corporation Name (if Cop )
rporati n, Name Rf Co . ). �T � AG/ S /
A. ess
ess
rev. 9/85
mk
ELLIS A. TARLTON•.,LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC..
CHEMICAL 34 PLEASANT STREET . DANBURY, CONN. 06813 -2328. MATERD LOGEwnTER
PHYSICAL � METHODOLOGY
BIOLOGICAL P.O. BOX 2328 203 - 748-7903 APHA -.ERA - ASTM
RL`p� T "OF- BACTERIOLOGICAL AND
-CHEMICAL 't IAATION'_OF' WATER
NAME AND SOURCE OF SAMPLE Water Supply
ADDRESS OF Wragg Brothers Healy -Model Realty
PERSON TO Lot #3 Fair St.
RECEIVE P.O. BOX 518 Patterson, .N.Y.
REPORT.
Wilton . Ct . 06897 I DATE OF COLLECTION 8./6/87,
DATA COLLECTED BY
Wragg Bros .
lydrogen Ion
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
:oncentration
LANGELIER
OM)
RYZNAR
NTU
Mg /L
Alkalinity as CaCO3
Fluoride (F)
Bicarbonate
Nitrite
Mg /L
Mg /L
Mg /L'
NITROGEN
Alkalinity as CeCO3
Chlorine Residual
Carbonate
:ONSTITUENTS
Nitrate
Mg /L
Mg /L
Mg /,L
AS
NITROGEN (N)
Total Hardness
as CaCO3
Conductivity
Ammonia
Mg / L
Mgt L'
M icromohos /cm
Mg /L•
Iron as Fe
Mg /L
Mg /L
Chlorides as Cl
Mg /L
Manganese as Mn
MCA
Mg /L
Detergent os.MBAS
Mg/l.
Sulfate as SO4
Mg /L 11
Mp /L
rho arithmetic mean of all standard samples examined per month using the membrane filter (echnique shell not . exceed MEMBRANE .FILT.ER TEST
3ne colony. per 100ml.- Coliform colonies per standard sample shall not exceed 3 /50ml1 4 /100mi. 7/200m1, or 131500m1 Collform Colonies /100ML
m: (a) Two coneaeulive sampfeh; -(D) More than "one` standard � sample hen less than 20 aie examined" per month: or (b)
More than five per cent, of the. samples when 20 or more ere' examinwed per month.. - 0
T THE TIME THE SAMPLE WAS SUBMITTED;
a1. The results of the analysis of this sample were satisfactory and met requirements for a potable water.
] 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical ,or physical constituents were high. These are as follows:
] 3. This sample was not satisfactory since It did not most the bacterial requirements for potable water. The presence of organisms of the coliform group In a sample of potable water is
underairable 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.
i
4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows:
COMMENTS
The bacterial analysis showed no organisms of the coliform.group
at the time the sample was collected whidh indicates the water potable.
1
certified ;. -"
d) k1' .
W64 P—OMPWION 119PQIFIT PWTNAM COUNTY DEPARTMENT Of NM@,TH
W79 Division of Envlrontnental Health Gavlose
COUNTY OFFICE BUILDINQ • CARME6, NEl4. YQNIS._.
- - —mit report '1 ; " "Itm'b Cornplo04 Wj diiW"Willh� and ouhmltteq to County Health.Departm0t together With'.laboratory roport of .
gn ®lysle'of.tro� tar sample indicating water Is of satisfactory bacterial quality before certificate of construction complillno ip laiuor
REPORT FAUST 13E SUBMITTED WIl`6iIN 30 "D1 YS OF•.W -Et,L COMPLETION
gwro0p M
NAMR A
APDR�S$
LOCATIOb. N
NR, 4 pliatle) aqn opt NYnI0a1
l OPOSQl1) t
t�ON} @STIR L...1 ESTAaI.I3"WNT L-a FAB4� ❑ T@ ;T W9ta
DRILLING C
COMPRESSED. C
CABLE OTHER
CASINO L
LFNQTM (/ofU. D
DI/!METEa(inches) WEIGHT PEA r00E C
CA4! f
0
eirrr�vL� L
FINAL SITE INSPECTION Date
l I pected by
,CATION �C�� ✓ � , �C`� -I �: ✓,. owNEaz 4YA
# f ' �U `B"1 # OR SUBDIVISION IAT # '��e ` x 1
-
- cavaas- . .
SEWAGE _ DISPOSAI; ARE ` -
a. SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier_. LGTH WIDTH AVG.DPTH
c. Natural soil not strippea
d. Stone, brush, etc., greater than 15' frcm SDS area.
e. 100 ft. from water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size :6,000,1/ 1,250
b. Septic tank instal evel
c. 10' minimum fran foundation
d. No 90" bends, cleanout within 10 ft. of 45° bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
--
3. Minimum 2 ft. original soil between box and trenches
---
f. JUNCTION BOX - ro 1 set
g. DIES
1. Length required install 1
-�
2. Distance to watercourse measured: ft.
3. Installed according to plan
1
4. Distance center to center
> up
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
.�
6. 10 feet from property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for sion, 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11: Pipe ends cappea
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber
'2: Overflow tank
_ �._•
3. Alarm, visual /audio
4. Pump easily accessible manhole to grade
�-
5. First box baffled
- -'
6. Cycle witnessed by Health Department
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrooms
WELL
a. Well located as per approved plans
b. Distance from SDS area measured ft.
c. Casing 18" above grade.
d. Surface drainage, around well acceptable.
OVERALL WORRMASHIP
a. Boxes properly grouted
b. All pipes partially backfilled
c. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
---
f. Curtain drain outfall rotected & dir.to exist.watercours
g. Footing drains discharge away fram SDS area
h. Surface water protection adequate
Q_ v
i. rosion control provided on slopes greater than 15C
1 19 J
10
i
/ �n.�.. -.tea ^7..i '}
{ / ?� ,�..� r
PU'd ICI AM , COUNTY ®�P
�kj, Division of. Enwrorimenialt_Hea /tl
Ac
CONSTRU , IOIV PERMIT F'OR,SE'WAQE pISPOSAL s-(. E
N _ocateil:;at Fa I.r �rr..Pet
Subdivision - A11Qin1 'f nrnearatinn subs lit rR
Owner /Addrese�ll,ol corporation =
euuaing'Type 1 Fam. i,ReS, Lot Area 1 Z'89 ac
:NUmber of BediooOmS Design -Flow G /P %D = Fi(1(1 p n'
Separate Sewerage System- to consist of 1000 Gal Sep
To be constructed'-by TO be-". determined
Water `Supply yy Public Supply '.From \
`Private - Supply to be drilled by - cTO be det
Address -
Other - Requirements
I, represent that I aML wholly and completeiy`responswie for the design and loco
above ;described will be constructed;as showh.on tlieapproved amendment theri
County.'f)_ - 't'rie'_ of ;;Health, and -that on completion` thereof a CerUf�caU
be submittetl to "the Departmenrit rid a',written %g. will be furnishes
place in good operating ;corid�tion any part of said sewage; disposal: systen
a'nce Of._the: approval of the Certificateot Construction Compharice of th
will be located as shoavn on .the approved plan and that said well w�li be installer
= 'county. 0epartmant of Health
Date r t h5r9ed n t
Address ch I nY snc,lates, P �'
APPROVED FOR. ?CONSTRUCTION This "approval "expires "one}yeac,from th
revocable for cause or maybe amended or'rn6drtretl when conisidered necessar
requireiTa' new' permit ','Appro a for'disgosal of';dome ic• nit y sewage
Date r' r '`BY
Rev: 9 -81
Permit '
N
"- Serwces Carmel lU 10512
? Patterson
Town or, ilage
roc
Renewal _,; - Revision _0 -
Date Of Previous Approval _
:Fill: SectionOnly
't P C.. H, D - Notification Required
Tank: and .375 "'L F , .x= 21 . wide. trench`
Address ,
rnuned ,
ion of 'the proposed system(s);-.1) that the separate Sewage, disposal system`
to antl m accordance wi61 '6 6iidaids, rules land, regulat ions o the -t Putnam, ,
of Construct,ori:'Compliance ; satisfactoryto,theCommissioniii l4ealthwi1l
the owner his wccessors, heirs off, assigris by the builder -that said buUde► will
"during -Ithe period of two:(2) years immediately'fdllowing t iedate,of the issu
ongmalsystem or any.repaus thereto; 2) that the drilled well described above
m accordance .with the 4tandard rules rid regu a wns ':of the! Putnam
i r P.E. x R.A
Lieen`se: No. 26 (1(1R'
date issued unless construction of the building has been undertaken and, is
by om rsswner of Health: Any :change,or.alferation of ednstruciion
an /or'prwat `water ;su DIY.. only "j
i
'PUTNA ",O"TY DEPARTMENT OF HEALTH,:—
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N., Y. - 10512
DESIGN DATA .SHFZT-SEPARATESEWAGE DISPOSAL SYSTEM I FILE NO.
)vine C) 4-1 CZ)j:Z:P, Address 7'o Xff/yT NU[RS1N<__A. 804jV)C--zs tv-,
Located at (Street) sec. 76�, Block
Lot • 18
indicate nearest ss street)
mvlunic�pality —,T-a IV Watershe d '(V
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH -APPLICATIONS
liole
19
22-
\cuniber CLOCK
TIME.
PERCOIATION
4;2,nt-23 4,
PERCOLATION
in
E.apse
Depth
to Water
Water Level.'
)9
No.
Time
From Ground Surface
in In6h6s
Soil Rate
Start-Stop
Min.
Start
Stop
Drop in'
'-Min./in drop
Inches.
Inches
Inches
1106-- 126)
f �
2/2c> 141
3141 "' —.2-1
(,:5
2,1
3
5 21A 7 323 3.6o 2
1
2/13 --i3-4.
19
22-
19
4;2,nt-23 4,
19
5 A,31-`-, 33) 0-
)9
22-.
:3 )2.
3,/6 2,2.
.3 .
�14
4
DOT.
od. Tm
5
'A
Notes: -1) Tdsits to be repeated at same depth until a'yyroximatelZ*bqua1 soil
rates are obtained at each percolation test .hole,,- A date, to e submitted.
'for review.
2) 'Depth measurements to be made from top. of. hole.
.A.
-4
TEST PIT DATA R&w- -.1RED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH. HOLE NO'. HOLE NO. HOLE. M
-1/811
,411
I I
3611
rt
,1211
48'1
54':
00 11
66"
'72 1,
,7811
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED .
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY 2S 2 Date
DESIGN
Soil Rate UsedI I j5_Min/1 "Drop: S.D. Usable Area Provided:
No. of Bedrooms 3 Septic Tank Capacity CEO Gals
Absorption Area Prov=,e . By �3- 7SL °F °x2?� "�b�`
me
c..
Address 37 _��_ SEAL
THIS
SPACE I'OR VSE
BY HEA11M DEPARTMENT
ONLY:
;3oil
Raise Approved
Sq.. Ft/Gal.
Checked by Date
8
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j 4
_ 7
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