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03652
F. ?...F PUTNAM COUNTY DEPARTMENT OF HEALTH
.Division of Environmental Health Services, Carmel, N, Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM % o Gt q dill
Town __Located at_�., ✓_ + � �'°+ � � See- -br � •or6 Block -3
Subdivision V �'� ����% /�+ a ,UL�� ^� Lot Job
Owner S - f / Address G?
Building Type Lot Area -J 5- °2 p — 76 7
Number of Bedrooms Total Habitable Space Q�e l/ A- Square Feet
yt�t�
Separate Sewerage System %toconsist of � Gal. Septic Tank / �•�' lineal feet X � F width trench
To be constructed by o A Address / P N
Water Supply: Public Supply From /1 h
—L� Private Supply to be drilled by 1/ ff'J jEC5 dA/'
Address X0 y
i
Other Requirements
IF
I represent that I am wholly and completel 8s oh and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as sho ` pr t there to and in accordance with the standards, rules and regulations o the u nam
County Department of Health, and t ificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and il,rf a wil ished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition an�p:pi of t ispo stem during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certifica o Conitp}�q% gel, rp lia the origins system or any repairs thereto; 2) `that the drilled well described above
will be located as shown on the approve p[!it an �th�t" iC� l,i'4dill in ailed in ac ordance wi the st artls, rules and regulations of the Putnam
County Department of Health,
Date J �fU 7l ��`+CrY ed ^^ P.E. R.A.
Address G, Q j�i7 License No. -mg, 7&_6
APPROVED FOR CONSTRUCTION: This appr year from the 'date issued unless construction of the building has been undertaken and is
revocable for.cause or may be amended or modified w necessar by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal o domestic s upply only.
r
Date 7 � By O Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
e- 12'
Vi 12 5
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �A`;,y ,�F �t��A/f�1 r/�Ce l'
Town or Village
yl� / la x/J<tP
t ncated at ,�' % f T t� 6lY /" 9ech Block
Owner
Separate Sewerage System built by
J`FJir'Tlc �)�L°i'�l�JJ' -tG
Consisting of �t Gal. Septic Tank - �O
Other requirements. �a
Water Supply:: Public 'Supply From
G._ Private Supply Drilled By
Address
Building Type IAff-.
Has Erosion Control Been Completed?
I certify that the system(s), as list(
attached), and in accordance wit
Date `� r
Any person occupying premises se %pri tffe ab
conditions resulting from such us
available and the approval of the a(
subject to modification or change �wh /tee% ,
Date
Lot °' Job
Address IV&si✓
lineal Feet X width trench
No, of Bedrooms Date Permit Issued
constructed essential y' as shown on the plans of the completed work (copies of which are
ions, p ns• filed. a -the permit is ued by ;fhe Putnam County Department of Health.
n
fled b.y. e rte' / r P.E. R.A.
License No.J 1 ,� 9
S) Ai promptly take such action as may be necessary to secure the correction of any unsanitary
to sewerage system shall become null and void as soon as a public sanitary sewer becomes
come null and void when a public water supply becomes available. Such approvals are
of the Commissioner of Health, such revocation edification or change Is necessary.
c_
By �� Title
9
YORt'OWN MEDLCAL LAORATORY II�C:
x
PA Roy 99.321 Kear Streat
.r VI A,1 ma• A V.
1i1�QR ..
IbO4` .
245-3203
FE
TE✓RI . PER�ML { gar plate "count at 35° C).,
COLIFORM GROUP "(Mosi probable No /100m1 }
HARDNESS ."TOTAL ppm
I ERG TS ;`ppm 3
NITRATES' (as ) - Ppm
IRON, TOTAL.; - ppm I
i
1
GUARANTY OF SEPARATE S: IAaE SYSTE 2
I represent that I am wholly and completely responsible for the
location, worlananship; material, construction and drainage of the sewage
disposal system serving the above described property, and.that it has been
constructed as sho v . on the app -P
plan or approved amendment. thereto,
and in accordance.:•rith the standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the o�rner, his succes-
sors, heirs or assi ns, to place in good operating condition any part of
said system constructed by' rr_e urhi ch fails to operate for a period of two
years i=ediately following the date of initial use of the sewage dis -josal
system, or any repairs made by :.?e to such system, except where tree failure
to operate properly is caused by the willful. or negligent act of the occu-
pant of the building utilizing the systarn. v
The..ur_,a� �lgnea fu,zt -':r �e"S _t_ � t - -a's
V a r a
"`�errriinatFon of. the Director of the Division of Environmental Health Ser-
vices 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 `' '. day of Y 19 Signature >
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
WNLL BRILLERIS LOG AND REPORT
4-7
VFell at County of
Nam of -Place-
Pity --Vd�l;-
Owner Pao 4 Address
Dept. of 3os f; Diameter
jield Was well ditKE _
n ctea?
ft* gpml yes or no
Amt. of casing above -ground.4
L�,Below grou'ndld' Well seal
in® packer, cement grouE
Draw a well diagram i n the space provided below and show the depth of
jeasing, the well seal, kind and thickness of formations penetrated, water
bearing formations, diameter of drill holes with dotted lines and
casing(s) with solid lines&
ti ELL DIAGRAM kih&tibNS _PENETRATED ; 7PUARKS
C'
25
50
75
i 100-
150
200
250
i
,thickness and Type - of well d-11-Ze
water bearing .... ... Drilling method , 12iix
D. tch of the property
on th
Was well dynamited?_
PUMPING TE STS
Details #12 #3
Static water
level, in ft.
below L_&rade
Pumping
in 9-ptmo,
Pumping level in
ft. below grade
Duration of
test., in hrs.
WATER AT END OF TEST:
Clear cloudy _Turbid
_
'Recommended depth of pump in
well, feet below grade
T1,T,LLS IN SAM & GRAVEL:
Sand Eff. size mm
Unif, Coef.
Length of screen
Diam, of screen -in.,
Type of screen
Screen openings x
ack of this sheet Drilling started
i locating the well and sewage
!disposal systems.
Well Driller-.-q
74 z
l nq MC) R(M
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date C
.`.Re ::. Property. of
Located atyI�� /"ci7`7r� (� lyl j C / "
Block 3 Lot
_14
Gentlemen
This letter is to authorize:. .;� STANLEY J. tANDER
a .duly licensed professional engineer 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 promulgated by the Cor�issioner of. the Putnam County.
Department of Health, and "to sign all. necessary papers on my behalf in
- =�- connection with this matter -and _t.o..s.upervlse. -.the construction of said
_. _. .
system or. systems in conformity with the provisions of Article 145.or
147, Education Lahr, the Public Health Law, and the Putnam County Sani
Lary Code.
Countersigned: ° !/
CTfl N 4 L-ANDER
AdZT1%
�gg�
BOX 267
M1Y! KVVr-xCR? 113. 1. IIII- .Jtl'�
245-2645
Telephone
Very truly. yours,
f �
Signed` .. =,
//0 wn r of Pr _ er,y
i
Ad " ess
Telephone
I
914 - 245 -3203
Yorktown frledical Laboratory
P. 0.; Sox 99_.,. 3.2.1 _Kear_,St._
Yorizt'o���r'i Heights, '.U.. .Y_e -v.. . ...:. .
The (r1eani.nq of_the !,Jater Ana l sis Report
A. H. radovani, M.T. ;ASCPY
This statement has been precared to help you interpret the .Vater Analysis
Report you have received. The purpose of this examination is twofold:
the determination of the total number of bacteria present and the
spccifi.c determination of the presence of members of the coliform group.
The item bacteria per P, 1L(Mi.11ititar) is a measure of total bacteria
present. One quart of water contains 940 milliliters. One ML of water is
added to a nutritive medium which acts as a source of food for the
bacteria. This portion of -avatar sari-io plus m3JiLlm is then incubated for
24 hours at 70centigradc. At the nd or .hut time, the organisms which
have grown and multiplied are counted. There is no limiting value for this
determination but it is of interost in judging the sanitary quality of
sample.
The second determination, the M.P. (V.. Probable Numbero is of more
s.Tccrtance since it is a specific test for one group of organisms, the
Colifer,m Group. The Coliform G_oup incli_rdos several species of bacteria
which are, more or less, normal inhabitants o' t,ic intestinal tract of
rnan and many other s. t;o:isaq�_rn;:'::ly, thoy are found in tremendous
numbers in fe-_-91 matt:-:_ a,-.d se aoe, The organisms of this group are
usually not dar;gerous iri t-ier!s3lves., but, when found, they do indicate
potentially durrgerous c nt �r %r:oti.cn sinsa _-3-j.-age at any time might carry
pathogenic or disase-•p_n-,ucing organises. the source of this contamin-
ation micht be s wagoe cyst;: is located too close to the well or
spritg. It mightr:.l;o re30lt Failure to protect the water supply
f., em surface d ~�.i,r-ag.c� ,.o. cc1 ta.-J.r:at_i_.cn._or. the en.tranco of uma1Z anim a 1s:.
"H "tide u"ira "t.er 3'' , is _. 3..-ed or cpened u�,it should `be' �ster.ilized r _�
by the ads iti ci , ?hlori ne i_n sr,:-.1c Form bef ere being returned to use in
cede= to el..e_n3tc any which might have been introduced.
AWN is a stotistizal tern which is used to o.; :innate the concentration
of these Cc._..foT•,,, ::1•nanisr , A ,t.atistical evaluation is used since
s e v ::a1 pa ti�r:s c: vG -- i;;d F, ize. °,rc sep:ar:-itel y cultured, A negative
test is indi ca t =d by a va 1uc of 1. ,s t•',c., 2.2., Any value other than this
i ndicct -os th:, pr; s;;nce 'a° C ^l.i'c-:.m crgari.s,es and gives roasan for stating
the s:.urce of tha sarr:ple is cl sati.: 'uc: cc This test requires a
minimum cf 1' G !, cur and, vr.l y cfter, 7296 ho,!rs.
It must be undcrstcl:d that tic results of this test apply to the water
sou -ce nn1_y at the time of sampling, Unusual conditions, such as hea.vy
rainfall or dre:ught, flooding, changr:,s or additions to the water system,
installation Of ;;?�L L tG- .11 o- c �_:3pools to the nearby area might all
hava effect on the saritary quality of the water Consequently, analyses
shc.ld be made as often as circumstances warrant.
T eye .. Govt: nm- pom. _.,-_ `
availabie From the Supt. of Documents,
U.S. Gc✓errrant Printing Os'f ice, Jashinq *on 25, D.C. which gives more
information on this and related subject;;. They are:
1. Individual !,Vater Supply Syslema
Public Health Sorvice Publication No. 24 - 256
Individual Sewage Disp ^sal System
� y set On, a
watertigi
pipe 0
slopes
r ` condit'
7 :R,
of y4
V. < ':
~ + inz peT fot+L,�
root proof
. 'ty '^ ."•. i'; IILl Ll.L I71U(1L Wt], 1J :�Fd'R'iwulll a C . .
-� ' i'" j�' minimum cover shall be used
tir " herever possible
'. ,Disoosal fields 'shall ;'bf
,e wide gLi'd of - tt�e.lengih;
i j shown o n the plans.
K i 6 "igr:detiii2s of septic
tank, dstrbu Lion 'box ,,and:
- j`unctton box, see tour ryy
i 4 Standards.
Lign.-of Dank gravel.shal
r F 2 J <be in place"three (3) moat
ins a lking Fields.
£
/4 l ' �{ r h iyn of bank' gravel stial
have a so
rat;9.6f' hot
lesp -than 2.5 gallons;. T
square foot- oer day "dn,
` .' :' its natural. state,'n -t1
, { a`i { borro tY. pit.
k
All trees in field
Cam` urea" and, iwithiri 101.
thereof 'shall .be
,. .
9 During -an�' con:.. ".
struction, ..keep heal
loads, oft field- area
r� 1l ; ` I7 Leader arid'" foc
; ing;-draias..must'. di
' r charge "away fsem
septic fields.
t3 } 11 �e11" log and
Ioa
` `, � " t , _— wate2 aae3y'sis vn
:� } { `submitteci .to,
<h C v �yFealth dept. 'beS
Gerxiiicat:e -._ o
Coristru�c.ton
C
r ComplL ce wil
r
_ + ) F . �f 't y buy ,�,� --•�, y /!
wz
K 4
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° ° v '� PREiY1 /SES SHOrVN .c/ER ,eON Z-:; j
/ OJ' 4, AS SHOWN O/V "S&WZ21111S 10N
C71- s�cTiav A" GL oC.giy/oRRq�-
\ 00 x� N ACRES," SA /O iY/9P E /L�U /N THE �,
R° (O� ��° j ' .oUTiV<7iYJ COlJNTy CL ERf(S OFF /GE
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SURVEYED & PREPARED BY
r It rs herpDy ertlr cA th -,t this urvpy�
BUNNEY,',�I►SSOCIATES was oretiered in a nrda ce wfh t1
``All certifications hereon are valid fix the map and conies o,
ENGINEERS & SURVEYORS "Isf.ng Coco of prartice for land .y.•n -'mot•
thereof ottly if said map or copirs bear Lire imprmsed
20 WOODOBRIDGE ROAD &urvays adopted by the New York f:tate
seal of the surveyor ti•h<me signafnre appears hereon."
KATONAH. MZL W YORK LOi!36
- AsoorWlon of Professional Land 9tirvgyofi;?'
N. Y. S. t_IC. No. 28694 SURVEYED AS IN POSSESSION FILE
i? .3B 8�z. •
w:r. c. area" ^,: 411