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02755
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02755
�1� PUT1�dAM CQUNTY EPA` RTMEP1'H" OF R ,1� NG I NEE MUST'
Divisron of Environmental Heft /tfi �Servaa, Germ% N Y' 1Ob12 ERM TE'#
F I
CERTIFICATE.)OF CONSTRUCTION COMPLIANCE FOR.;;SEWAGE "MISP.OSAL SYSTEM
sun age
Located 'a`t • ' yr ■ �� 4 /d`� Tax Map .� Block 7...
owner asi. Formerly _ Tax,.Map Lot _s, _ 'Sn � SubdOLot
Separate Sewerage.5ystem'buflt•by�' Address���% Quift�J1�/ O,�f_
c
Consisting of /.Ad D 6—al. Septic Tank: and � y Z 4%G 'D�oa
Other requirements
Supply From '
Private
Water Supply: Public S Supply •.Drilled BY s
0
Address G
Building Type
Has Erosion Control Been
I certify that the system(s)
of which are attached), and,
Putnam County Department Of
Date
Any person occupying premises s
conditions resulting from such u
available and, the approval of the
subject to modification or Chang
Date
Rev. 6/85
21
No..of Bedrooms :. Date Permit Issued at 'Z -Z= im—
'Has garbage grinder been installed ?_
the above premises were constructed esaentially•as shown on the`plan6 of the completed work ( copies
the atandarday rules and regulations, in accordance wlth',;the filed plan, and the permit issued by the
e
P.E. " R.A.
L License No.
i a• maybe necessary to' secure the correotlon of any unsanitary
jme' null'And void is soon as' a ' publlc, sanitary ewer becomes
ublic` water ;.supply becomes available._ Such approvals are
such revocation, modification or change Is necessary.
llaryy
Title A P 8
Yorktown )Medical Laboratory, Inc. LOCATIONS:
❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203
321 Kear Street. 01 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737 -8777
Yorktown Heights, N. Y. 10598. ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666 -3335
(914)245 -3203, ❑ STONELEIGH AVE. (PEAR HOSPITAL). CARMEL, N. Y. 10512 278.9330
Director: Al ert H. Padovani M. T. (ASCP)
-- _
DATE TAKEN:
DATE RECEIVED:
GATE REPORTED:
SAMPLE SOURCE: G Lab #
REFERRED BY.
L_ J Collect
// [� / Q✓ LABORATORY- REPORT
6 mg /L 2
51- 067- i
❑ ACIDITY ........................... ............................... ❑ ALUMINUM ............................................ .,
❑ ALKALINITY i. . P= ........ ... A= ....................... ❑ ANTIMONY ................................ ...............................
P�$ACTERIA, TOTAL /mL .......... .�� .. .......................... ❑ ARSENIC .................................... ...............................
❑ BOO, 5 DAY ............................ ............................... ❑ BARIUM ....................................... ...............................
❑ BROMIDE ............................. ............................... O BERYLLIUM ................................ ...............................
❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ...............................:.... ...............................
❑ CHLORIDE .............:.............: ............................... ❑ BORON ..................................... :.................................
❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ...............................
❑ COD .................................... ............................... ❑ CALCIUM .................................... ...............................
❑ COLOR (units) ................. ............................... ❑ CHROMIUM (tot.) ............................ ...............................
❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hezavalent) .................... ...............................
❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .................................... ............................... a2,
❑ FLUORIDE ..:......................... ............................... ❑COPPER .................................... ............................... A
p
❑ HARDNESS ............................ ............................... ❑ COLD .......................:................ ................................ �4
❑ MPN COLIFORM COUNT/ 100 ml ❑ IRON ' ........................................ ...............................
A^MFT COLIFORM COUNT/ 100 ml � ........................... ❑LEAD ........................................ ...............................
❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ............................... /
❑ NITROGEN, AMMONIA ........... ............................... ❑ MAGNESIUM ................................ ...............................
• NITROGEN, KJELDAHL ................ ❑ MANGANESE ........................
• NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................................... ...............................
❑ NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ........................................ ...............................
:............:.::........: a �aLLi�alt,lv�• ..= ....:.:: ..
................... C r.:.....:....
❑ OIL & GREASE ........................ ..............:................ ❑ POTASSIUM ................................ ...............................
❑ PH (Units) ...................... ............................... ❑ RHODIUM .................................... ...............................
❑ PHENOL ............................................................... ❑ SELENIUM ........................ ............................... ........
❑ PHOSPHATE (ortho) ..... O SILICON .........................
........... ............................... ........... :......:.......................
❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ...............................
❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ...............................
❑ SOLIDS. SETTLEABLE, ml /L .... ............................... ❑ TIN ............................................ ...............................
❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............. ........................... ...............................
❑ SOLIDS. DISSOLVED ............................... ❑ .................................................... ...............................
❑ SOLIDS. TOTAL ..................... ............................... ❑ .................................................... ...............................
❑ SOLIDS. VOLATILE ................. ............................... ❑ REMARKS:............,...................... ...............................
❑ SPECIFIC CONDUCTANCE ( UhIDO S / cm ) ............... ❑ .......................................
❑ SULFATE ............................. ............................... TNTC = Too Numerous To Count
❑ SULFIDE ............................. ............................... < = less than (below detectable limits)
❑ SULFITE ............................. ............................... RS _ Recommend Sterilization of Source
❑ SURFACTANTS ....................... :. ........... . ...... ......... FSBT = Filtered Sample Before Testing
OTURBIDITY ( NTU) ............... .4.............................
THESE RESULTS INDICATE THAT THE WATER WA OF A SA- TISFACTORY SANITARY
QUALITY WHEN THE SAMPLE WAS COLLECTED
THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM-
I -AL Q?jFATER ITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS,
D NK STANDARDS (PART 72) FOR THE PARAMETERS TESTED
LE WAS COLLEC,�ED;
�j �c N/A = not applicable
�l 4
Albert H. Padovani M.T. (ASCP), Director R W F 8 5
U7- AAM 6-L
Owner or
chaser o Building Section
_ ... .. ,....W_ .. >:...,,_ ..,N.u...�...,...
3.1
Location - Street Lot
PUZV 401
Municipality
Building Type
Subdivision Name
Subdv. Lot #
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent 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 success -
or's, heirs or assigns, to place in good operating condition 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 occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
_ a-t-ion of the--fdrector- of the. Division of Environmental Health Services
of the ~Putnam County Department of Health as` -io 'whether" or -no't" the fail-
ure of the system to operate was caused by the willful or negligent act
of 'the occupant of the building utilizing the system.
Dated this ?v3 day of •.J 190 Signature
Title
1'4�`24 &W
Corporation Name if Corp.
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
DAVID'[). 8AUEN
County Executive
Mr. Bill Zieler,P.E.
Concord Road
Mahopac, New York 10541
Dear Mr. Zeiler:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
February 18, 1986
Re: Englehardt SDS CC
Rock Hill Road,PV, TM 37 -3 -3.1
Permit PV 17 -85
JOHN SIMMONS. M.D.
Deputy Commissioner
Per Mr.;.Clemen's request,2 am reiterating the requirements as set forth
on the Submission Requirements dispatched to you on or about October 8, 1985.
Specifically, the as -built plan must reflect the house location relative
to the property line to accurately locate the SDS on the lot. Additionally,
the location of the well, as it was installed, must be shown on the as -built
plan.
Upon receipt of revised plans, review will continue. If there are
,any questions, you can call me at 225-3838/3833.
Very truly yours,
s S. Hodgens
Assistant Public Health Engineer
JSH /jp
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
WELL'.COMPLEi10N -REPORT PUTNAM COUNTY DEPARTMENT OF :HEALTH
31711 ,
Dlvlsion "of . Einvlronrnental Health Services
COUNTY, OFFICE Bt"LDING CARMEL, NEW YORK'
this report is to be completed by well) -Ater and submitted'to County Health Department together with laboratory report of
analysis of water sample indicati%water is of..satisfactory bacterial quality .before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30. DAYS 00 WEL4 &C)WL TIOid
NA ADDRESS
:OWNER i
(N
LOCATION o. rroet! _ (Town) Ylot NumAer)
Of WELL
BUSINESS
PROPOSED ® DOMESTIC I r ESTABLISHMENT C� FARM. a TEST WELL
USE OF'
WELL SUPPLY INDUSTRIAL CONDITIONING �• (SpoEfy)
DRILLING ® ROTARY C�:AIR; ERCUSSION D P RCUSSION (OSocify)
CASING LENGTH(lesl) �' DIAMETER(IntAes) WEIGHT!ER,FOOT.
i,.
No ° Y[S.. No.
DETAILS. ' -; • � THREADED , , D , ,
THRE WELDED YES �..
R oPM
YIELD
YIELD I t
HOU S IfIE O.I•Y )
TEST - .� BAILED +L�'PUTr1PtD." n ED "A
WATER(, MEASURE FROM lANO SIIRPACE ST�TI6(SpeclfyJse!►DUR NGYIEID�TEST,flse!). DepM� of CoinpletodWell t� .r
rLEVEL foot below;:P11d,UliFalg� r? +�
MAKE ; IENOTM•OPtN TOi'AOUIFER'(liiti
SCREEN
DETAILS SLOT .SIZE ; i.: ' DIAMETER (Inc hea) ' GRAVEL Bill ( • reel) To. - ,
►ACKEOi i 0►aveP pock (!1chos);
DE ►TN PROM LAND SURFACE "' _SMetcA ixAct Iowtlon of yell wlM dlatMGet 't0 at Nal
FEET to fEET FORMATION DESCRIPTION two Or ivehont IiinOma►ka ' "
If yield wat felled of different depths during drilling, list below .
FEET GALLONS PER MINUTE .
DATE Ell OMFLETEO
DATE OF REPORT` WELL ORI R'(S ure)
NSi
Jrr 772'1
Zocat�L
Yiocated
ed
FSubdivisibn 42,
ly6i/Addrebs
Nurn6ei -of Bedio6i
tia arit4:Seweroge System-,t6: cod
7 77"
-T
Water ,Supply _Public
Address
7 b
, thW,.-'Requirements
represent
above _lQbq constructed
�.County:;0epartment of Health �i
,wi
b.ik submitted to: the Oepbrtment,
place !n,.goqq . operating -.conditibi
approval 6
_._ance, f _the
I . 'b ' located - .- , 5nqhi 4 . Pp
Y�!M; @: %,��-V_00�1!! j
�.'CoVneV, Qvpart rnept�of�Hva iih
date —C
n con
rritei
rt.- of
Con
n and
Z'.
I
HEA
c
TIr
S # Renewal 0 Revision
DateOf Previous Approval {
P 'C H '.',D;: Notift
n �Requi
�� Gal Septic Tanks and @C 'tf
�U
;Raw
F,
f!
by
A,
t
5
'37
:6r ,t ie design a 4-116dit i df bf th_' th'U,the�lsepAra a sewag- e 'disposal sys am
ivied amendment there to and'in accordance;w;ith the standards rules _gulat ions -of .-4 the Putnam
ed
rteejwill be furnished missigner6f.Realthiill
-
-too, o" !
.,
i thereof a . Certificate of Construction Compliance satisfacLOry to '4� V y �
i d'er that hat'sa'id-py' lider-,wil
wage disposal system bu W�.idlioWi ng th6catelcf thqIssu
jeCpypliancpAo�t h ri i system any re firs re that tped filled well deici'64d above-
.
d accordance . les a , togs- f_the Putnam-
,
io
K,
U
cense.>.. o
one -- �r-f, r A, h issGed_' unless ' itr J'1 ng as+ n undertaken
!-considered Fe necessary thi-.Co stoner, of c an , terajlb6df co
rstructio"n
/or_ a�
Title. . . . . . . . . . . . . .
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL L HEALTH: SERVICES
_._.;_C.0`UNT-Y- OFFIODE-z
DESIGN DATA SHEET-SEPARATE SEWAGE *DISPOSAL SYSTEM TILE NO.
C. 0i g i C.,L) 6a gj&-r Addre s s z )0v7-WM V 6
'Lbdat'ed at (Stroet�indica _flocl<A'16c -Sec-. Block Lot 3.
t e nearest cross s ree
Municipality POAj4m 11,4ccgx' Watershed..
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS.,
Hole - ,
Number CLOCK TIME
PERCOLATION
PERCOLATION.
Eiapse
Depth to
Water, '
water Le-v-Ul
No.
Time
From Ground Surface
in Inches
Soil Rate
stdrt=Stop
Min.
Start
Stop ,
Drop in
Min./in drop
Inches
Inches
Inches
OD
/0
Z7
3.3
2 /Z.00 !Z: 16
/,C
zY
17
11:16 /2:34
A?
z
.3
41z_jY 12.-�l
/7
zy
27
1 /0:01 /Zj.j /Z_ ? z
Z49
3 /21� 22 4Z
/-Y 7 Z' 0 .3-
5:
2
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 from top of hole.
r .
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTi 1 HnL NO.
G.L.
6"
12"
18" ,
2411
. 30rr .
3611
4211
4811
54 ri
60"
66"
1211
.l8 n
8411 V
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE_ LEVEL TO. W T C,Ti . WATER FL., RI_ SES : AFTER. - BEIN
TESTS ..MADZ Fii
DESIGN
Soil Rate Used 7 .Min/1 "Drop: S.D. Usable
/0atj e—�
G ENCOUNTERED
Area Provided ,5`0 0 f- Ste'
No. of Bedrooms .3 Septic Tank Capacity l 900 Gals.
Absorption Area Provided By 3 G 6 L. F. x24 —� b`"—
0), Z ,
Address
0- 3. �i�� /.-O
a// Z!�k, ZI/v
Mu
SEAL 'w
cove,
trench.
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Raise Approved Sq. Ft /Cal. Checked by _,_`_� Date
d , .
V... IV♦\ U4 Ii J /J1
Mcets Std.
L') I C_
Roma rks• .
01
es ho (_-
DOCLM711TS
d plans' U . x.
Design data sheet
Peres presoaked? ./ 1
i.? n.� 30" perc test depth /
Const. results for 3 runs I ,r
D. Hole lot; O.K.
Corporate Affidavit for other than individual ! .
Authorization for engineer I
Letter from •later . Supply if applicable J
If variance requested -such noted on plans &apps.
DETAILS _ _
Sif change-is proposed',
Existing contours shown ishow new contours) V/
Slopes for driveway cuts, etc. shown
lZater service line location
Footing drain, etc. location ! :,% I °«•
Top slope, bottom slope of fill FS,
.percolation.tests and deep test pit location
Seotic tank size and conformance to std. i
3 B.R. housa min l r;um
House setback shown
Distribution box ftg. below frost N� !
All water within 50 ft. of. PL shown , �C M
Plan and profile SW
All other wells and SDS closer 200'
shown or- reference madz
ropery'"b'ouridares metes and bounds - clearly s own ;
XlS
-I F& pPPe0v4L
REAzTY SuQDI�ISICIJ �,J
Ws✓TC.kNt� � DEC PAM � -rs 1 .- - - - - -- --- • -...._ __- - - � - -- -. ........ ............_..
ISEPARATION DISTANCES SPECIFIED ON PLM
!10' to P.L.
201� to Foundation valls
TOO to Nearest well
ICYl'to stream, march, lake, etc. Incl. expansion
5' to Curtain drain
0' to water line (pits -20
5' to storm drain
�
0' ' to lar`,e trees
0' from l'0 lllld.1t toll •to soptic t:alll:
5' to pipe from leader drain & .1'ooLinj:, klilaiti.
� Z5 To . "TC.4 S 11J
iJi's►�L'
12,
4. . k
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
': : ,v < w '..`a. h..�:.. .r.b --.._ -••c -..t ...R.. -. .. .�.... ;r. w. .'n.. a•�. -�� - .:. .,. ,.�.+.•. - . -..v • .s:a. �-.b'
'Date
Re: Property
Located at X'0C1 <1�Fl (-L /c
(T) Section Block Lot 3a
Subdivision of 8L. � t
�L A�oS �',oa•/r�dd'A ���auJoo� .S�a1o�c.S
Subdv• Lot # r8 po�rid,J Filed Map # 2.7 -Sr' Date
r
Gentlemen:
This letter is to authorize lG G — G
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
�._. ... -gy-s `.!2�;!z .'C.i _ w..�*^ s�'.i1u i a`i t U iiv ii.ii y' N7'1 i1 --the —AT' 1C1'eY,14i5�OY i
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code-
GGjjjj r
Countersigned;�•/!� 3��k
P. E. A., # 7�4FX%
2�1 // A/ z�v
Address
Telephone
Very truly yours,
S i gn e d- J'e'z� &Z�
Owner of PMperty
Address
Town
--5* J�6zoO,7�
Telephone
l
R1ET.,T) CI�tT.rl: L'CST. . Dato
r- L t ICU I. I
DI rTIAL SITE TDISPrCTIO ?I �
Yes
No
Comments
,Property lines or coriiers found .. ..
_
Gan cstima.te house location . . . . . . . .
Wi:11'. driveway need cut
--
Mmst trees be removed -note these
Is deep hole . representative of entire SAS dreg
-Addit:i.onal deep holes needed. . "
_ --
✓
_ --
Sufficient; SDS area available consi.der:ino
driveway cut, house. location, separation .... ;
'di stance s, etc.'
._ --
to-o , —Tye
DEEP HOLE EATS
Dapth:.
hater elevation.: POP C
Rock elevation:
Soil descr_i�ot•i on :
Date:
FINAL SITIE DISHEICTION, Insp. by,
House located where on approved plan
SDS located where approved . . . . . . . . . .
: T ong i;h of t;rcnch mea su��ed ;C,,"
W id tit of trench avera Se
Slope of the line and trench. acceptable
Room allow C* d for extension trenches
-
Over. 50- .- ft,.,- _;fr._om. swamp j- .,atercours
- I:ja'Luo- �ib%— s't�ippsd dr -SDS` area
'
imecessarily graded ... ..
_..
10 T't. maintained from prop.line and
20 ft. from house
Sep.nra.tion of trench from house, well
-- etc. —follows
--
Tumber of bedrooms checks
Stone, brush, stur,:ps, rubble, etc*. greater
-'
than 15 ft . from nearest trench
�-
15 I't . of peripheral soil horizontally from
trench
Junction boxes properly set
r
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS
aroa
Doc.,--; lot dra.Lna .e apr-C ar 0. K. :i.n area of SDS
✓'
;f' 1 L�; �- {(�;,�
FINAL GraDING Or SI%2E ACCEPTABLE
.,aLj�z �ajuo_-._
_l.
�1
SOA
'or 4
Sf -
L.EC.END '
O SePrmT rr 40Fo/ /6'
. .. o Tuveriavdar . �
• Pcfc�<Aria.✓TesTy�E II — I
o
VACANT
A/o orAF? WC[LS O7-NE2 TiVAN —,tvA� r =.l /ST ^✓�rYtW 200' OF SDOQ
,fae Izl- .PiAO
Putnam County Department of health
Division of Environmental health Services ow"'
Approved as noted for conformance with 04,9W
applicable Pule; and - Regulations of the
Putnam'Coun'tyI Health Department. reRCE:��`SO'
ANC 3-4-6A
`Slghature &Litlq� Date
4 "D /ve1r..P. 0 - 2'Rc?9 F.c /--FO e Y
e,we - C-Prle 704W
P�POF /LSE �
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