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03650
v\ \:c PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. '10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley
Town or village
Located at Shamrock Drive 68
Tax Map--- ��.:�—
The -C .
Ownero- un .r tLCae?nr - Tax Map Lot # 3 subd. # 19
Separate Sewerage System built by _The Country Carpenter Addressf
Consisting of 1000 Gal. Septic Tank and 30OLF of Leaching Fields R:yys
Other r• ti
eq u irements r�`•a
Water Supply: Public Supply From
XX
Private Supply Drilled By Na Anderson
Address trPutnam Vall ,NS' 10579
Building Type One Family RESYDENCE No, of Bedrooms 3 Date Permit Issued = 9/6/84
Has Erosion Control Been Completed?
I certify that the system(s) as listed .serving the above ;
g premises were constructed essentially s shown on the plans of the completed work (copies Y;�•
of which are attached), and in accordance with the standards, rules and regulations, in actor ce with the filed
Putnam County Department Of Health. Pan, and the permit issued by the
Date 3/28/85
Certified by P.E. R.A. XX
Address MuSCoot No. RFD 2 x 48 Maho ac NY1054 icense No. 11056
Any person occupying premises served by the above system(s) shall promptl to such a ion as may be necessary to secure t correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage em sh become null and void as soon as a ublic sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public ply becomes av liable. Such approvals
cub)eet to modNlcation or change when, in the Judgment of the m stoner of Health, su revocation modification or change is neeessay. are,
date � � _ �./ �
By
Title . _.—�..
17V 1,
i
!. PUTNAM `. COUNT DEPARTMENT OF HEALTH 40
Division of Environmental Health Services, Carmel, N. Y. 10512
tk,.
CO RUCTIQN —PERMIT.- .EAR- SEWAGE DISPOSAL, SYSTEM -
p r /� /�, /� Jr., wn or -village
CQf /T �JA�lln eOCO1 t(/ - Tax Map �Ca Block � �
Located at c Q ;
y. Gla Cd 0%Orra. Lot
e2 10 10 �) J� Job
Subdivision Set■ 1
Owner r ..�
Building Type�r
Number of Bedrooms Design Flow
�
Lot Area —.1
Separate Sewerage System to consist of 5� Gal. Septic Tank
To be constructed by M Swty /i 11 s �. -
Water Supply: Public Supply From
X Private Supply to be drilled by
Address
Other Requirements
I represent that I am wholly and completely responsible for the design and location of
above described will be constructed as shown on the approved amendment thereto an
County Department of Health, and that on completion thereof a "Certificate of
be submitted to the Department, and a written guarantee will be furnished th
place in good operating condition any part of said sewage disposal system d ng
ante of the approval of the Certificate of Construction Compliance of the o
will be located as shown on the approved plan and that said well will be Installed i accii
County Department of Health.
Date �`' t 0 Signed '
Address
Address��
Total Habitable Space l � j Square Feet °.
and /6' [ .id'f
Address
��s); 1) that the separate sewage disposal system - -'.'
tandards, rules an regulations o e u nam
1m -satisfactory to the Commissioner of Health will
3 0 ,s a( assigns by the builder, that said builder will'.`,' _
two ea •immediately following the date of the issue' > ",
r he o; 2) that the drilled well described above y
an )� ,( rules and regulations ons of the Putnam s
{ P,E...111C R.A.
w
License No,
L tk dis
APPROVED FOR CONSTRUCTION: This approval expires one year from the date i Q n of the budding as been under a en an
revocable for cause or may be amended or modified when considered necessary by the ealth, Any change or alteration of construction
requires a new ermit. Approve�dy for disposal of domesticr sewd/ priv e w ter supply only.
0 r 1.0 By Title
nnro
4,
. ,, r s�7 +s_'�
" PLJ4NAM• COUN'T'Y 'DEPAkTME1VT OF ,HFAd,TH Permit a
Dwision of Environrrienta/ Health Services ;t arms/ N Y' 10512
CONST
RUCTION" PERMiT FOR= SE,WA`GE _DISPOSAL SYSTERfl °` k w Putnam•4 Vall -ey
t 1 p i L ks ` TOwn Of 11�/ 1898 r
Located at S'ramrock DrlUe Tax,Map' 6.8; Block 5 rot 3'
n f�
$UbdiVlSfiOn orr ESxt S.eCt: 'B Subd Lot H lS7 \ fi Renewal '•tr 'r RCVlSlon _� M
Dirnei /Address o �.:w; drub oak ^NY lo5aa al' 7�a4
_� f, t -Date Of' Previous Ap ,
r P
Builtling Type Orie Fam Res Lpt AA ea 1 Acre Fill gection O„ly n
r
P C H D' Notlficetlon Re
Number of Bedrooms Design Flow. G /P /D quired
t
Separate'Sewerage system td consst of 100'0 Gai` Septic TankT ^and! 300 ;LF O;f F1:21'dS
To`be co s�ructeday M Amorosano Address 'BOX 431 Shrub Oak, NY 10588.
Wafer SuPPIY a Pupii! SuPP1Y
r L
a
-..r Private Supply to be drilled by
>.+ r ti r t.t
Address , Y., $'arger 5'treet, Putnam Valley,. NY 10579
Other Requirements -
I represent that I am wholly antl completelyYresponrsible for�the esfign and location of the proposed systems) 1) Ghat the'separbte sewage :'disposatasyitem
above described wfill be constructed a34shown on4th'e-approved ame tlment there to *and n,accordanee wdh ,tire stantlards rules an r u a ons'o ?` a u tram : '+
°'° .....u"' ,. _
County Department of Health, and; `tthat on,completfion thefeof a .,,Certifficate :of:;Constructlon,Comphance satisfactory to ,the Corritnissioner of Heatthwill
,.,,,,, .. Y.., 's:' ;, . e ,.,., ':.A!• 7 'Sa:;':.:. h. a' .Y'2"lw';.P.4:n'R.-'ia.. ri Y.:.F;
be ,submitted Ito the. Department and a written guarantee -wtq De fucnfished the ovine[ his wccessors sirs Or assigns by ,(he buUder. that !;aid builder
....r. .., .
s place m good operating contrition ;any partsof 4safid�sewtigedfisposal system duffingythe period oft 2) year ;'immediately following thedate of the issu
:1..ka n.G'.r .. r..,.,
once of thi' iipproval, of the ;Certifficate of ,Constructions CompUance of the ouginal system.or, any a firs thereto 2) t 8t the drilled well _described _above
._: E,w. 1s..,_, 6 -.> z -- s -_. ..
will, be located as shown on the approved plan and that -said well wfi11 be instplied cordencenwith he stbndards rule _anG regu a„ons +ofd: the ::Putnam'
Count Oe artment of a _ Y` r
Date 914%84 n Signed a' �^ !' P E R A XX
�_ Adtl.e :: Muscoot North RFD
X:-4 Maho ac Lic n :e No 1.1056
a
APPROVED FOR CONSTRUCTION Thii.approval }expires one. ar from +th t is u d les3';consfruc4fion of the buildi g has; been untlertaken:;and is
reyocatile for cause or may _be amended or moditfied w ` "� consfiGered n essay bY, heCo` of Health ='Any Chang `o -alteration of construction,
;r quires a new p it Appro d i r dfispo3el of tlostic saridar via %or to wale ply onl
`Date#" ^ BY e� °f . ti? Tfitle -
R
4
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPCETION 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 Healt
vAli% ui►� u►V•
LOCATIONS:
P.O. Box 99 321 Kear Street
- U 321 KEAR ST, YORKTOWN HEIGHTS, N.Y. 10598 245.320:,
Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOO.AVE., PEEKSKILL, N.Y. 10566 737.8777
E1.49.5 -MAIN ST.,.MT. KISCO, N.Y.,10549 666.3335
O STONELEIGH AVE.1(NEA Ht35PiiALP; C'A�iiAriE'L, N. Y:1'd5f2)E3 93 "r�
r �
� 0, 3
LAB #
DATE TAKEN:
r
DATE RECEIVED: "
DATE REPORTED:
SAMPLE SOUR E:
:BRED BY:
COLLECTED BY:Ai. Cam. ,*
LABORATORY REPORT
mg /L
❑. ACIDITY .................. ...............................
❑ ALUMINUM ................................ ...............................
....
❑tOD. ALKALINITY ..................... • ).tl.........:........
ACTERIA,TOTAL
❑ ANTIMONY ............................................................... ..
❑.ARSENIC
5 DAY......... ...........................
O BARIUM .......................................... .............................
O 'BROMIDE ...... ................. ..
O BERYLLIUM .... ... ..... .... ........ .... .
❑ CARBON DIOXIDE, FREE ...
❑ BISMUTH ..: .. ............ ... ................ .....
❑ CHLORIDE ......... ........................... :..............
O BORON .................... ...... ............................... .......
OCHLORINE ......... ........................................
❑ CADMIUM ... ".. ........... ............................... .....
OCOD ........................................... ..
❑ CALCIUM ..................................................... ...............
❑ COLOR ......................................... .....
O CHROMIUM (tot.) ................................
❑ CYANIDE .... �
� -❑ CHR.OMIUAA,(hexavalent) ................ .............................
❑ DETERGENT, ANIONIC... ..., ...........
❑ COBALT .... :: ....... ............................... .......
..
FLUORIDE ............................ .. ......
❑ COPPER .. ............... .................................................
❑ HARDNESS .:.........:....,.. ..............:..........:..:..
O GOLO ......... ......:......:.... ...........................::.. ..
MPNCOLI FORM COUNT/ 100 ml ........ ..
MFTCOLIFORM COUNT/ 100 ml . ............
❑ IRON .... .............................................................
❑ LEAD .......... ...................................... ...... .
O CONFIRMATORY TEST ..•.
❑ LITHIUM ....... ....
t NiTRtJuEN, AMidGP +ART ... .s.a. ..
MAGNES'IUM - — c...:n� ::::.ar. erc.. sa.7u.P. w h:.� • ..• -_. __
O NITROGEN, KJELDAHL .......
❑ MANGANESE .........................................
, .
NITROGEN, NITRA ,
MERCURY ..
NITROGEN. ORGANIC ..: .... ....
O, NICKEL'
`❑ ODOR - ........ .... ...:. ..... ..: :.. .......
❑.PALLAOIUM ,
i
D :OIL &GREASE :. ............... .•4•
❑ POTASSIUM
04 ..... ................................................
❑RHODIUM ...............
:❑
..,•
:b PHENOL .:. ' ........: ....... ....... ...:' :.
D SELENIUM .: „
O PHOSPHATE (onho) ..................... ..:. ......
;, r ❑ SILICON
❑. PHOSPHATE (condensed) `•• .•`•. ..• ••••
❑ SILVER i
O PHOSPHATE ltotall ..
.,.;,
O SODIUM
❑ SOLIDS.SETTLE,ASLE mt /L
❑TIN .. .. ....
0 SOLIDS, SUSPENDED
❑ ,ZINC
❑ SOLIDS. DISSOLVED
❑
.
O, SOLIDS TOTAL a ....... .... .... ......
-
Q
"O SOLIDS VOLATILE .
O REMA'^RI�4,S�,�
r
D SPECIFIC CONDUCTANCE ; ..
O •.
.D SULFATE
..0: •• ••.
00 .� , •vy n
•�n-'
.: O SULFITE
O.
/ yy
'O SURFACTANTS -; ...... ..y:. ......» .:.....
,
"❑ TURBIDIT"
U
'
TH£SE RESULTS ?INDICATE THAT THE WATER
;WAS,- .. OF-A SATISFACTORY SANITARY QUALITY WHEN
THE "SAMPLE :WAS COLLECTED
'THESE INDICATE':THAT.TIIE WATER
"DID MEET T11C SAT SFA R1' C1IEPIICAL QUALIT
' >`EW''YORK STATE ,ADMINISTRATIVE RULES 6
.
RECD
-' FOR , THE PARAMETERS TESTED.
WELL COMPU*6 REPORT PVTiVAM COUNTY iDE1►ART1N lT O.F. HEALTH
3171 - ;
of'Einvl►onrrnntN HNItA $aMas
COUNTY:OfFICE, SUILDINQ CARMEL,.NEW YORK
This "report is to be completed by well Filler and submitted to County. Health. Departrttent topsther with laboratory report of
analys s.of water Sample indicating water is of satisfactory bacterial quality before certificate of,coostruction compliaiice is issued.'
R-EPQRT, RLj4T•.8E. SIJ�MdTTEI�;WETH119 .30..[2AYS O.F WELUXID MIPL:kTIOf�I
s,
ADDRESS_ ..
OWNER
LOCATION, (No. &S%irs o (Tow (Lot Number)
OF WELL_ /�� , ^ %QS /7 `~
PROPOSED'
® DOMESTIC ❑ ESTAB ISMMENT. ❑FARM ❑ TEST WELI ,
USE OF. yy
WELL ❑ SUPP Y - ❑ INDUSTRIAL ❑ CONDITIONING ❑ fOSpecifyj
DRILLING � ❑ ❑ CABLE O
EQUIPMENT ROTARY A R PERCUSSION PERCU SSION i�h)
,
CASING LENGTH (lost), I DIAMETER (I rhea) WEIGHT PER FOOT CASIR 'f--
DETAILS::.. ( I? THREADED` ❑ WELDED „YES NO YES ',' NO
YIELD
HOURS G ►AAYIELD (3 P.M.) ..
TEST, ❑ bi►ItED ' ❑ PUMPED_ COMPRESSED AIR, .;
WATER
MEASURE FROM LAND SURFACE— STATIC (Speelly ULleet) DURING. D TEST INt)
4ipth of Con, 1141 VVdI /
LEVEL In fad below lord surface=
TO
MAKE IENOTH,OPEN TO AQ""' 0060 SCREEN
DETAILS- SLOT SIZE' DIAMETER (Inch*#) AV EL SIZE (Inches) FROM deal) TO (leer)
IF GRAVEL Diameter of well includin
g
PACKED] gravel pack (IncAera)i
DEPTH FEOWLAND SURFACE - - Sketch exact location of wall, with dktanaN, t0 at lelat
FEET to FEET FORMATION DESCRIPTION two permanent landmark*.
1 `-1
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE 'Ell C PLET D I DATE OF REPORT, W
a
1
,,.ru•s4�- o��
t
liw- w..,
ate,
Veit
i
A EA.= -d3 S8q 5F=
1. Sao �►� --w`Z _ 1�
¢ Icc) EtlC,
1� �1
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&Cou ►1 u j
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VL �' rim+•+ 1�
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y
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FTG OP —AIN5
NO LE APE 2-5
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Az g4 ;3 =oS� 1`�•`�� 3
L•O�.�I'Z' Z4 `T
2 27` 3S
(f
- - - -L-AYO U T
With
Of tha
- - - - --
�5_P�UJL'r..$ AGE :D.ISP04ML : 'UT_ JOEL LAWRENCE OAE[MaEQ®
Ml E CO.U.NTRY__CAR.E-EC'1.7EK 1NQ,, 'ARCHITECT - TOWN PLANNER.
SMl►AARa_G MUSGO ®T mosTIB ploolAos 488 0
-.may 10641 O
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL. HEALTH SERVICES
Date September 4, 1984
Re: Property of Michael Amorosano
Located at Shamrock Drive
(T) 68 Section Block 5 Lot 3
Subdivision of Glocamorra Estates - Section B
Subdv. Lot #,f 19 Filed Map #
Gentlemen:
Date
This letter is to authorize. Joel Lawrence Greenberg
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 supervis-e ..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.
C
Cou t rsi ed:
P # 111
Muscoot North, `RFD #2 B"x 488
Address
Mahopac, New York 10541
914/628 -6613
Telephone
2/84
Very truly yours,
Signed• '
Owner of Property
P. 0, Box 431
Address
Shrub Oak, New York 10588_
Town
914/225 -6424
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date km ° e�D Qg e
Re • . Property. of 6WO46n AOej 44,e#' F V Q)
Located at Ld/9 roae cwt (tae //a
Section (y Block S- Lot
Gentlemen:
This letter is to authorize
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
vUj11jt!v L.i.Vll w.1 Lf1 L1116 ma L Let' anti to. supervise the curistruc Burl 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.
F N
1 A.
Counte'
Very truly yours,
Signed
Owner of Pr rty
q Address ® i
P.E.,
_
M °- ® ' eR omc Telephone
Address
XA
D ®3C
Telephone
,._ PUTNAM COUNTY DEPARTMF",VT OF IT] .ALTH
fi DIVISION OF FNVIRONTTTJTAL HEALTH SERVICES
- COU3V 7 OFFICh,'FlIILDIPIG;, CARIVn7J,, -PJ.
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Address r ` ,
'S J. Gi17 (�0t)/JT12L.T 1-'D4 �{5�� ,".........
Located at (Street &Q4-M 49, �kl2ak -- Sec. Block 5 'Lot
n i.ca -e nearest cross street)
Municipality. Pv .PA-M yAt •. Watershed
SOIL PERCOLATION `PEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOI:4TION PERCOLATION
RIM Elapse Depth to %.a ter Water revel,
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1 go�_JS
�S
1 `�►
2�'
q4L;
4
5
4 0
3
5
1 -
Note:: 1) Tests to be repeated at same depth until a roximatelyy equal soil
rates are obtained at each percolation -test hole. All dattl to Ue 'submitted
for review.
2) I>:Pth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS. ENCOUNTERED IN TEST HOLES
4 DEPTH- _ HOLE _ �y
NO . �1-. ( HOLE NO.-
H
G.L.
6" TcP;oll�
12"
18'►
2411
30'F
36��
42„
48"4
54"
60 11 ,�na�- �.� -fivr�
66"
72'
78"
a
84 l
INDICATE LEVEL AT WHICH GROUND WATER .IS ENCOUNTERED ��� l
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED i
TESTS MADE BY Date
D IGN
Soil Rate Used 5 MirVlllDrop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 7 Gals.... Type Y7n A'z*- )►'Q-�
Absorption Area Provided By f �1 D L. F.x24 "�'— "F h rent .
Name Wju.ixin A, FL i E gna ure
�y�!
�f N'•Ti;�3
Address Tn osr DK!cc "boy-
z
Z)LL2 PAQ. L LA, 2-A,
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
..mss, sto
Soil Rate Approved Sq. Ft /Cal. Checked by Date.-