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03659
:'ENGINEER MUST
L PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE
Division of Environmental Hea /th Servioss, Carm% N Y 10512 PERMIT
CERTIFICATE OF CONSTR ION COMPLIANCE FOR SEWAGE DISPOSAL :9V* EM J�' {o g 114
Town or Village
"'Lncafed` at f
y-i f., � l / / Formerly Tax Map Lot # . / /s' Subd. Lot #
Owns l
Separate Sewerage System built by F. ti✓� ' "� Address
Consisting of /Z3_0 Gal. Septic Tank and
Other requirements
Water Supply: $ublic Supply From
Private Supply Or By
Address y
Building Type�_� Cif'
Has Erosion Control Been Completed?
le_ Z�'
0
No. of Bedrooms — — ,— Date Permit Issued
Has garbage grinder been installed? .r'Y° &-
I certify that 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 accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Certifie Dy�� P.E. R.A.
Date
Address
G/! a�'/�G✓m' ti'" +'' s� License No
Any person occupying premises served by the ab system s) shall promptly akd-ad aetion as m e.necessary to secure the correction of any unsanitary
conditions resulting from such usage. Appr 1 of the separate sewerage system shall b=m call and void as soon as a public sanitary sewer becomes
available and the approval of the private wa er supply shall become null and void. when a public water supply, becomes available. Such approvals are
subject to modification or change when, in the Judgment of the Commissioner of H th, such revocation, modification or change Is necessary.�i�
G
Date � By Title
Rev. 6/85
CONSTRUCTION- PERMIT-'
Located at ✓ e.a 7,
Subdivision r►.
r
PUTNAM COUNTY DEPARTMENT OF HEALTH Permit #�–� —=-=C�
Division of Environmental Health Services, Carmel, N. Y. 10512
SEWAGE 1.111SPOSA' SYSTEM1_
t 1/yy ,s Town or Village
�� `' Tax Map �° Block r� Lot i4 cep
Lot # C. Renewal _ 1:1 Revision _ ❑
Owner /Address 4Yy—i i_ /l 1 A7'7 1 19)
Building Type ! , e -'s , Lot Area a " 3
Number of Bedrooms !— Design Flow G /P /D ge(->
Separate Sewerage System to consist of 2 4i Gal. Septic Tank
To be constructed by
Water Supply: ,-Public Supply From
—� Private Supply to be drilled by
Address
Other Requirements
Of Previous Approval
Fill Section only
P.C. H. D. Notification Required
and
Address C�
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the stantlards, rules and a ons o e u nam
County Department of Health, and that on completion thereof a "Certificate of C pliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee will be furnished the heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system i t4aveP'io years Immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the riginj* °sy Mg s thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be install with( '
County Department of Health. an Y$ �� st Bards, rules and regulaTIons of the Putnam
Date __� /� 1 S Signed P.E. R.A.
Address •
y o ` ' �` � ° ° License NO.
APPROVED FOR CONSTRUCTION: T is approval expires one year ;r m th .islre uules c$ti dtion of the building has been undertaken and is
9
revocable for cause or may be amends or modified when considered necessary t}ti�C0 'ist nIr�' !Health. Any change or alteration of construction
requires a new pe it. Approved for disposal of domestic sanit ry sewage, ant! r pr e',vJ° er sb(piy only:
Date � By ` Title -
A
Rev. 9 -81
r
December 21, 2000
Via Registered Mail, Return Receipt, requested
Bruce R :Foley
Public Health Director -DOH J1
1 Geneva Road �°/ _•;1
Brewster, N.Y. 10509 �(v
Robert Morris
Senior Public Engineer -DOH
4 Geneva Road 1 A�
Brewster, N.Y. 10509 Vv
0
Gentlemen,
01/1 V eff-11 ,
�0
�S
lam' la
I am writing in further reference to my telephone conversations with Mr. Morris on Tuesday December 20, 2000
and January 4, 2001.
First, let me start by saying that although, this well issue has caused me a great deal of anguish, all my other
dealings with various county officials have been extremely positive as evidence by my complimentary letter to
Carmelo Santos dated October 12, 2000 (attachment #1).
Let me also state that as a controller, I don't profess to be familiar with the various sections of the health code.
As you know, my C.O is still pending the resolution of the well.
My well was not built within the approved area. In essence, the well is less than 4 feet of neighboring lot. It is
my understanding that the well needs to be 15 feet from the property line. At your December 2000 meeting the
waiver on my behalf via my builder was denied. Up to this point, all the information you have received has come
from the engineer consultants, my builder, and land surveyors; and before any attorneys get involved, I feel
compelled to tell you why if this wavier is not granted I will be hurt three times.
Here is the reason why, if the waiver is granted, I will be unjustifiably hurt.
First and foremost, I still believe that if the county had not made an error back in 1989, I would never have had
_...._. _ __.. __... _:... to 3tg a_u1eh:.to begin. wtth.:please_note Lh t.on attachment #2, that a «fell v�as`iii glace back iz 1985. Yen may
want to refer to map 74, block 1, lot B, of the "subdivision map of property prepared for Marie & Diana Milani"
which was filed in the Putnam County Clerks Office on June 5th, 1985 ". At that time my lot had a good well.
Four years later a house was put up on lot C Butterfly Lane. For some reason they allowed the construction of a
septic tank to be built within 100 feet of my well. At the time I purchased the lot, I negotiated a price based on
this 1985 map under the assumption that I did not have to dig a well. Of course, the septic on Butterfly Lane
came to light during the application of a building permit, and we had to abandon it (see attachelmnt #3).
It is my position that I have already incurred a $4,000 expense as a result of the county allowing the septic to be
built within the 100 feet, forcing me to abandon my well. In this regard, I am formally asking the Putnam
Department of Health, under the Freedom of Information Act, and as property owner who has suffered by the
1989 septic error for full documentation on why and how the house on Butterfly Lane was allowed to build a
septic tank when clearly there was a well within 100 feet. Lot Con Butterfly Lane is over 15 acres. Clearly there
was enough land to figure a way of building a septic that would not infringe on my well rights. Mr. Morris
indicated to me that your health department has been unsuccessful in locating the documentation. This is a case
of what came first. Before we order the construction of a THIRD well on my lot, the burden falls on the county
to justify to me the reason I was forced to build a second well to begin with.
On the subject of the septic in the property in question on Butterfly lane, let me point out further that at least
one septic drain is currently spilling above ground in my property! (See attachment # 3 showing the septic
in my property). I never questioned the neighbor nor the county on how this came about, or why the county
would have approve a septic design which literally allows for septic spillage to discharge on my property.
Normally, this would not concern me, nor has it until my well location became a barrier to certificate of
occupancy.
!f
j
dM
January 4, 2001
If the waiver is not granted, I will be hurt unjustifiably a second time. A third well will triple the cost for this
p'*tcf the ors *�nrtic.;_ -... .. ... .
The third way I will be hurt is by the fact that on the day of week before Christmas, I finished construction of a
concrete and cobblestone patio and walkway a few feet away from the well.. The cost of this project is $12,500.
(I will be happy to provide you with documentation with the dates and cost for this project). I posed the
question of the effects of digging a well would have on the new concrete patio, and was told that "there is a good
chance that the pounding of during the digging could cause cracks on the concrete ". Further, as you know the
house is built in certain sequence to minimize damage. I will receive further damage transporting the well rigs
into and out of my property. Keep in mind that the house is now completely, done, the paint and all the molding
will start to show cracks during the well digging.
Finally, I have been informed that my well poses no health issue. On top of this, there are no infringement rights
issues. If requested I am prepared to get notarized letter from my neighbor on Butterfly Lane to state that he
will not peruse an action against me because the will is not set back the required 15 feet. You will note in
attachment 4, that the well location is not in proximity or view of the actual house on Butterfly lane. From the
point of view of the owner on Butterfly Lane, it does nothing -it sits behind the wooded area.
As this letter was ready to go out, I received notice that a conversation took place between Bruce Foley and Arne
Nordstrom, the Chairman for County Legislature. I am told the waiver was denied specifically for the following
two reasons:
First, it was explained to Mr. Nordstrom that the original well was a test well. The fact is that this is not true. In
the certified land survey done by Bunny Associates done back in 1985 its clear that there was a good well dating
back to 1985 (attachment 2). This simply was not a test well.
Secondly, it was explained to Mr. Nordstrom that the well "was moved 60 feet". Well, this. it true. However, the
original location of the septic was relocated to improve the grade from the septic tank to the field.
The relocation of the septic tank necessitated the relocation of the well to�"tain the required 50 feet
distances. Cronin Engineering did the new location of the septic in conjunction with Adam Stiebeling, the Public
Heath Engineer. The well was moved over to compensate for the movifig of the septic tank, in the process it was
moved over, and unfortunately too far back so that it no longer conformed to the 15 foot requirement.
^ T In conclusion, we are not denying, that by some unintentional error, the well was not drilled within the 15 feet
requirement. However, under the circumstance mentioned above I am asking that you approve wavier in your
next meeting scheduled in January 9, 2000. This will avoid me incurring further unnecessary expenses, and will
end this entire appeal process that would continue beyond the January 9ei meeting.
Thank you for your consideration in this matter. I anxiously await your decision.
If you have any question do not hesitate to contact me at work at (212) 410 -8737.
Sincerely,
AAnthopyMirdita
CC: Iry Sevelowitz, Bldg Inspector
9
December 21, 2000
Bruce R. Foley
Public Health Director -DOH
1 Geneva Road
Brewster, N.Y. 10509
Robert Morris
Senior Public Engineer -DOH
4 Geneva Road
Brewster, N.Y. 10509
Gentlemen,
Via Registered Mail, Return Receipt requested
I am writing in further reference to my telephone conversations with Mr. Morris on Tuesday December 20, 2000
and January 4, 2001.
First, let me start by saying that although, this well issue has caused me a great deal of anguish, all my other
dealings with various county officials have been extremely positive as evidence by my complimentary letter to
Carmelo Santos dated October 12, 2000 (attachment #1).
Let me also state that as a controller, I don't profess to be familiar with the various sections of the health code.
As you know, my C.O is still pending the resolution of the well.
My well was not built within the approved area. In essence, the well is less than 4 feet of neighboring lot. It is
my understanding that the well needs to be 15 feet from the property line. At your December 2000 meeting the
waiver on my behalf via my builder was denied. Up to this point, all the information you have received has come
from the engineer consultants, my builder, and land surveyors; and before any attorneys get involved, I feel
compelled to tell you why if this wavier is not granted I will be hurt three times.
Here is the reason why, if the waiver is granted, I will be unjustifiably hurt.
First and foremost, I still believe that if the county had not made an error back in 1989, I would never have had
` x g..aavel� t� -be •vvitdp , Izlces n e ghat on.atta hs er t #2 that a -yell was 4h plate baei; iri -1985 3�o`u sway — : ,
want to refer to map 74, block 1, lot B, of the "subdivision map of property prepared for Marie & Diana Milani"
which was filed in the Putnam County Clerks Office on June 5d, 1985 ". At that time my lot had a good well.
Four years later 'a house was put up on lot C Butterfly Lane. For some reason they allowed the construction of a
septic tank to be built within 100 feet of my well. At the time I purchased the lot, I negotiated a price based on
this 1985 map under the assumption that I did not have to dig a well. Of course, the septic on Butterfly Lane
came to light during the application of a building permit, and we had to abandon it (see attachemnt #3).
It is my position that I have already incurred a $4,000 expense as a result of the county allowing the septic to be
built within the 100 feet, forcing me to abandon my well. In this regard, I am formally asking the Putnam
Department of Health, under the Freedom of Information Act, and as property owner who has suffered by the
1989 septic error for full documentation on why and how the house on Butterfly Lane was allowed to build a
septic tank when clearly there was a well within 100 feet. Lot Con Butterfly Lane is over 15 acres. Clearly there
was enough land to figure a way of building a septic that would not infringe on my well rights. Mr. Morris
indicated to me that your health department has been unsuccessful in locating the documentation. This is a case
of what came first. Before we order the construction of a THIRD well on my lot, the burden falls on the county
to justify to me the reason I was forced to build a second well to begin with.
On the subject of the septic in the property in question on Butterfly lane, let me point out further that at least
one septic drain is currently spilling above ground in my property! (See attachment # 3 showing the septic
in my property). I never questioned the neighbor nor the county on how this came about, or why the county
would have approve a septic design which literally allows for septic spillage to discharge on my property.
Normally, this would not concern me, nor has it until my well location became a barrier to certificate of
occupancy.
-2— January 4, 2001
If the waiver is not granted, I will be hurt unjustifiably a second time. A third well will triple the cost for this
part of tbe. :cor1strUc1:012 :... . ... ... ..... .....- .......
The third way I will be hurt is by the fact that on the day of week before Christmas, I finished construction of a
concrete and cobblestone patio and walkway a few feet away from the well.. The cost of this project is $12,500.
(I will be happy to provide you with documentation with the dates and cost for this project). I posed the
question of the effects of digging a well would have on the new concrete patio, and was told that "there is a good
chance that the pounding of during the digging could cause cracks on the concrete ". Further, as you know the
house is built in certain sequence to minimize damage. I will receive further' damage transporting the well rigs
into and out of my property. Keep in mind that the house is now completely, done, the paint and all the molding
will start to show cracks during the well digging.
Finally, I have been informed that my well poses no health issue. On top of this, there are no infringement rights
issues. If requested I am prepared to get notarized letter from my neighbor on Butterfly Lane to state that he
will not peruse an action against me because the will is not set back the required 15 feet. You will note in
attachment 4, that the well location is not in proximity or view of the actual house on Butterfly lane. From the
point of view of the owner on Butterfly Lane, it does nothing -it sits behind the wooded area.
As this letter was ready to go out, I received notice that a conversation took place between Bruce Foley and Arne
Nordstrom, the Chairman for County Legislature. I am told the waiver was denied specifically for the following
two reasons:
First, it was explained to Mr. Nordstrom that the original well was a test well. The fact is that this is not true. In
the certified land survey done by Bunny Associates done back in 1985 its clear that there was a good well dating
back to 1985 (attachment 2). This simply was not a test well.
Secondly, it was explained to Mr. Nordstrom that the well "was moved 60 feet ". Well, this it true. However, the
original location of the septic was relocated to improve the grade from the septic tank to the field.
The relocation of the septic tank necessitated the relocation of the well to maintain the required 50 feet
distances. Cronin Engineering did the new location of the septic in conjunction with Adam Stiebeling, the Public
Heath Engineer. The well was moved over to compensate for the moving of the septic tank, in the process it was
moved over, and unfortunately too far back so that it no longer conformed to the 15 foot requirement.
In conclusion, we are not denying, that by some unintentional error, the well was not drilled within the 15 feet
requirement. However, under the circumstance mentioned above I am asking that you approve wavier in your
next meeting scheduled in January 9, 2000. This will avoid me incurring further unnecessary expenses, and will
end this entire appeal process that would continue beyond the January 91h meeting.
Thank you for your consideration in this matter. I anxiously await your decision.
If you have any question do not hesitate to contact me at work at (212) 410 -8737.
Sincerely,
i
Anthony Mirdita
CC: Iry Sevelowitz, Bldg Inspector
_ lWriirtta
_ - 38 Park Drive
Pubiam Valley, NY
10579
October 12, 2000
Carmelo Santos
Town Supervisor
265 Oscowana Lake Road
Putnam Valley, New York
10579
Dear Mr. Santos:
I am in the process of moving from the Bronx to Putnam Valley.
My wife and I, after a long search process finally were convinced that Putnam Valley would be the best
place for us to raise our four children, all under the age of ten.
OF course, building a new home would present many additional challenges. It actually produced more
challenges than I could have imagined,
I am however, happy to report to you that the one area during this project that I always got complete
cooperation was from many of your departments. In dealing with the various agencies to get questions
answered, I was expecting to get caught up in the agency bureaucracy that I have been accustomed
to. On the contrary, all my calls were returned, the questions were answered to my satisfaction, and I
never got pushed to another department.
I would be remiss if I did not specifically mention Iry Sevelowitz, the Building Inspectors who guided me
through the inspections process; Carl Sandburg, who answered all my questions as far as the
methodology regarding town and school taxes, and Ms. Mendez for making the school transition very
smooth.
As Controller of a nursing home, I always stress the fact service differentiates us from our competitors.
Certainly, your staff has already embellished this concept. 1 congratulate you and them for the extra
effort they have shown to my family during this transition.
Once again, thank you for your personal attention.
Sincerely,
�nthonyy Mirdita
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of�i�
Located at
(T) 4o,A �Aa Section 6 Block Lot / t
Subdivision of
Subdva Lot # Filed Map # Date
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
connection with this matter and to supervise the construction of said
at'etti `uf' "S %�nl ""Y ��Ti7CClririit ` tii. :e..:- `rovisioris' "oi K`r`it"icT'e' 1 5'_or: _._. ..._
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
g ''1 as OF A
P.Ea, ,
Telephone
Very truly yours,
Signed
Owner of Property
Address
Town
Telephone
I
7W
Date: -7-
1=p. by i
INITIAL SVJTE 1.11SPECT1011
YC'3.
No
Commontn
Property l.inu. or corrv.•s foul-irl . . . . . . . ..
Can estimatr-1 house. location . . . . . . . . . .
Will driveway nec:d cut . . . . . . . *
Elust trees'', be removed-bote these
Is deep hole. representative of entire SA. area
Additional-deep holes needed. . . . . . . . .
Sufficient ;SIB area available considerinf,
driveway- �cut, bou,-c location, separation . . .
dis•artccs,4 etc . . . . . . . . . . . . . . .
.
DEEP HOLE ]1Vrh
Dapth:
Water el 'e,,mtion:
Rock elC�-Xicn:
Soils
Date:
FIJI. L SITE Insl-.). by:
House located where *shown on approved plan
S113 located 'yhero approved . . • . . . . . . .
Inn Lh of trench m3asured
Vidth of trench aver-n-e
Slope of tilo line and tr_ei)_cF._acccptable
Room allowc(f for expansion trenches . . . . .
Over 50 ft.-•from swailip,watercourse
•1atural soil,, not stripped or SDS area
Ulul rily e raded . . . . . . . . . . . .
ecessa�
10 111t,,maijitai e maintained from prop.lin and
20 fr.6 ill house
Se1x1a,at J. on of trench from house, well
otc. folloi',?s plan
Rumber of 15carooms chocks
Stone::, brush, - stu-.!ps, •ubble, etc'. greater
than 15 ft. from ncarest trench . . . . . .
15 Ft. of periplicral soil horizontally from
trench- * ... . . . . . . . . . . . . ... . .
Junction boX§s properly set
Qoii3.d surface rim off from driveway, roads,
-ground surface, etc.. chaff -mel near SDS . . . .
area
Dz)c,.,--. lot drsllfm "midar* O.K. `in* area of S*DS,
FIVAL GRADINC Or SITE ACCEPTAME
DOCIJV�IITS
U.9,3 ;.plans O.K.
D,-sif,,n data sheet
Peres ; presoaked?
Pere tool; depUl
Const..' results for 3 runs I
D. Hole lor., 0. K.
Corpoiate Affidavit for other than individual
Authorjization for engineer
Letter from I-later Supply if' applicable�;
If variance requested-such noted on plans & apps.:
_18QY_44 LSWITIA R r- C" 0 ::r rv-D 7
D-7TABIS
.;-ILL D6PItA RREA' Sjjot.W( Cf) MM'"PLAN ro me- rao v'__
Exist-�pg contours shown (show new contours)
_d
Slopes'for driveway cuts, etc. shown
I•Later service line location
Footift` drain, etc. location
Top slope, bottom slope of Pill
Percolation tests and deep test pit location
SeDti&7 tank size and conformance to std.
B.R. hpuse minimum
House: setback shown
Distribution box ftg.. below frost
All w4ter within 39,'�'ft. of PL shown
We,.L- -12 SING IZII fizove- GP_A-C>C
Pliniand profile SDS
All other wells and _SUS closer '200s-1
qhbwn or reference made
Property boundaries (metes and bounds-clearly s
1 PEA04 b IQ I < , I
SEPA13AT !ON DISTANCES SPECIFIED ON PLAT
10, toA,%L. )pkNiqu_)Ptj
,201� to walls
100 tol earest well
IOU' to stream, march, lake, etc. (incl
45' toXjurtanin drain
O to. water line (pits-20
5' to.&�torm drain
{10", to 1"Irce trees
10, F1,0111, 1,01111datioll to
%11}111_11C.
15' to ryij)c from leader 0_0 U1 —5
IM TV, ETC14 QASII3
15' WEiL TO 0
E6P IC. TRMk, TC,
on
I
14A
A
PUTNAM COUNTY DEPARTMEff OF HEALTH v DIVISION OF ENVIRONMENTAL HEALTH SERVICES
a INDIVIDUAL WATER SUPPLY SUBSLktFACE SEWAGE DISPOSAL SYSTEM
d.:
F= INSPECTION REPORT l '�
DATE
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO CMENTS
Wetlands on/or proximate to property ..............
Property lines or corners found ................
Can estimate house location ........................
Will driveway need cut .....................
Must trees be removed - note these.................
Deep holes representative of entire SDS area......
Additional deep holes needed... ... .... ..........
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics ............................
D.H. 1 Lot
Depth to G.W.
Depth to rock
0
£t.
3
ft.
6
ft.
9
ft.
.......12 -ft
Soil Descr
I-
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil Descril
0 ft.
3 ft.
6 ft.
9 ft.
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
Soil Descr
DATE: / 7 `•,
FINAL SITE INSPECTION INSP.BY:/ % >�'�
0
ft.
COMMENTS
3
ft.
6
ft.
9
ft.
v
Soil Descr
DATE: / 7 `•,
FINAL SITE INSPECTION INSP.BY:/ % >�'�
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over-100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ..............................
10 ft. maintained from property line and
20 ft. fran house ..............................
Distance well to SSDS
N=ber of bedroans checks .................
brush, stumps, rubble, etc., greater
Stones, UIi�S,
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set. . ..............................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE ..................
v
/-S
>
W
IJ
2
Yorktown .Medical Laboratory, Inc
321 Kear Street
a Yorktown Heights. N. Y. 10599
(914k14!0203
Director:, Albert H. Padovoni AL T. (ASCP)
L eh✓'_ .
L
fl, -7)V J
LAB I
Collection itnVion u- sed:�i`
Carmel _ Peekskill
Mt. Kisco Bev City _
Date °is"i"eri.
Date Received:`
Date Reported: //a
Collected By:
Referred By:
Sample Source: ' Gc
LABORATORY REPORT ON-BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
bl Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
YEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform per 100 ml
Fecal Coliforr, ner 100 Ml
Fecal Streptococcus per 100 ml
YOST. PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: 14PN Index ner 100 ml
�J
�,/
- '2 (,,,' 72--
Fecal Co1i e ..-p.. fru--Ml �` •-
form. t�PN_.Ynd. x e ..�.
OTHER ANALYSES
THESE RESULTS INDICATE THAT TAE WATER SAMPLE (WAS NOT) (NOT APPLICABLE)
OF A SATISFACTORY' SANITARY QUALITY ACCORDING 0 T NEW YORK STATE DRINKING
WAT STArRDARDS FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
LEGEND
Albert H. Padovani, M.T. ASCP), Director RDS Recommend Disinfect-
ing Water Source
< • less than
TXTC • Too Numerous -Too
Count
f�
N
---ti
1
THESE RESULTS INDICATE THAT TAE WATER SAMPLE (WAS NOT) (NOT APPLICABLE)
OF A SATISFACTORY' SANITARY QUALITY ACCORDING 0 T NEW YORK STATE DRINKING
WAT STArRDARDS FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
LEGEND
Albert H. Padovani, M.T. ASCP), Director RDS Recommend Disinfect-
ing Water Source
< • less than
TXTC • Too Numerous -Too
Count
A/ 1`•='0/1\
WELL UUFrLLT1UI,N , ALrUZ -1
DEPARTMENT OF HEALTH
Division Of Env_r- onlnental Health Services
�wD PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
STREET ADDRESS: TOWNIVIL alcill, TAx GRID NUMBER:
WELL LOCATION
.
WELL OWNER
NAME. A ESS:
-
Z P8IVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
%RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑. INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
ANEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
� .WELL DEPTH / ft.
STATIC WATER LEVEL
TftDATE MEASURED % 3
DRILLING
EQUIPMENT
14,�OTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG. .
❑ WELL POINT. ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING.` OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH �'r ft
MATERIALS: ,STEEL O PLASTIC O OTHER
LENGTH.BELOW GRADE U ft.
JOINTS: O WELDED 01HREADED D OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT O BENTONITE ETHER
WEIGHT PER FOOT / S� lb./ft.
DRIVE SHOE!�YES ONO LINER: 0 YES vo
SCREEN
DETAILS -
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
OYES ONO
GRAVEL PACK
YES
O NO
GRAVEL
SIZE.:
DIAMETER
OF PACK in.
TOP
DEPTH tL
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed, pumping
METHOD: O PUMPED i tests were done is in-
[COMPRESSED AIR ,formation attached?
BAILED O OTHER ; ❑ YES O NO
1A1ELL LOG �f more detailed formation descriptions or sieve analyses
Y J are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Oia-
In
FORMATION DESCRIPTION
qOE.
ft.
(t,
WELL DEPTH
ti.
DURATION
hr. min.
DRAWOOWN
ft,
YIELD
gpm.
Surface
Z r2
3Y
%
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES .ONO
ANALYSIS ATTACHED? O YES O NO
l /
STORAGE TANK: TYPE
CAPACITY �a o GAL.
PUMP INFORMATION
TYPE `�� CAPACITY .S
MAKER DEPTH 01-010
MODEL /4 — VOLTAGE 7-3u HP `
WELL DRILLER NAME DA
ADOREA� SIGRMRE
��� "-:;IP7Y- z2 o�
%.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building Section Block Lot
4
Building Constructed by
Location -,Streef-
Municipality
�GJ •
Building Type
Subdivision Name
Subdivision Lot #
GUARAN'T'EE OF SUBSURFACE SEWAGE DISPOSAL 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 successors, 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 approval of the
"Ce.r- tificate.. of. - Construction. Compliance" for the selvage: disposal.. system; -• or -any
repairs made by m6 -tb !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 Environin?ntal 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.
0
�-• 0,
Dated this .2) day of Oc G lr&191
General Contractor (Owner) - Signature
BRESC.IA BROTHERS CONTRACTING
Corporation Name (if Corp.)
0,
rati ame (if Corp.
Alfdf es 07
21 Lafayette Ave, New Rochelle, N.Y. 10801
Address
rev. 9/85`
mk
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF.ENVIRONMENTAL.HEALTH SERVICES
:,._;. _...,. COMiTy ,OFFICE: BUILDING; CARIZt; .:N.: Y: 10512 °.
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner /Vas , ;
Address
Located at ( Street 1 � � �� Ll,,,.-, e,.Sec : �. Bloc kLot
45dicate
rilarest
cross street)
Municipality b, 6zn i, t
� e_'U Watershed
SOIL PERCOLATION TEST DATA
RE UIRED TO BE SUBMITTED WITH APPLICATIONS
'Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION._
Elapse
-Deptft to Water Water Level
No. Time
From Ground Surface in Inches
Soil Rate•.:
Start -Stop Min.
Start Stop Drop. in Min. /in drop ':'
Inches Inches Inches
30 IS'
4
5
5 -
1
2
3
5
Notes: 1) Nlkts 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.
DEPTH
G.L.
.24
3011
3611
421 1
48"
54-11
6011
66"
7211
7811
TEST PITDATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST-HOLES
HOLE NO. Y J HOLE NO. HOLE NO.
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
iT -EF T
QH-'-WAT- WATER --LEV-PL'-RI*g�.L,,�F..TER-BEING-ENCOUN
TESTS,- MADE BY Date `
DESIGN
Soil Rate Used v/' Min/l Drop: S.D. Usable Area Provided
ao-us
No. of Bedrooms ej- Septic Tank Capacity Type
�y 14
Absorption Area Provided By4��<-- L.F.x24"- 110.�"� width trbnch.
Other
4'a ,
I ij VICsAA
Address
.
THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: ... tv-
Soil Rate Approved Sq. Ft/Gal. Checked by Date,
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,
7Y
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72
41
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