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Putnam / Poughkeepsie Diagnostic Laboratories, Inc.
10 Roneleigh Avenue, Carmel, N.Y. 10512 914/225 -5563
Merrill Industries
Mark Ritter
Route 9
Fishkill, New York
WATER ANALYSIS REPORT:
6/21/74.
COLOR
Odor
Turbidity
PH
Hardness
Soap Hardness'
Chlorides
Manganese
Iron
Detergents
Nitrates
Ammonia Nitrogen
Albuminoid
June 24, 1974
Less than 5.01
Absent
Less than
2.0
5.0
y~
6.7 grams
per gal. (calcium carbonate)
8 grams
per gal,..
20. oppm .
Absent
Less than
0.5 ppm.
Absent
Absent
Absent
Absent
There were no colforn bacilli isolated from the speciman
s�ubm tted.
interpretation of results:
At the time of examination the water was of good quality.
Jascli C. Guice
Putnam Diagnostic Lab., Inc.
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
� /
fro 1_L �( vt u 5
ADDRESS
f' -
l' i S �c �- I t iv M -3
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM aTffi WELL
1:1 SUPP Y El INDUSTRIAL 1:1. CONDITIONING ❑ (specify)
DRILLING
EQUIPMENT
/ CO f RESSED ❑ CABLE ❑ OTHER
ROTARY R PERCUSSION PERCUSSION (Specify)
CASING
DETAILS
LENGTH (feet)
DIAME/TER(Iche
GHT PER-FOOT
HR ❑WELDED
EADED
ES ❑ NO
W
CASING
YES NO
J
YIELD
TEST
HOURS G.P.M. ,�
❑ BAILED ❑PUMPED COMPRESSED AIR
YIELD (G.P.M
WATER
LEVEL
MEASURE FROM LAND SURFACE -STATIC (Specify feet)
DURING YIELD TEST Jeet)
&14"r->
Depth of Completed Well �!
in feet below Land surface;
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feel)'
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches).
GRAVEL SIZE (inches)
FROM (feet) I TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of -well with distances, to at least
two permanent $ndmarka:
FEET to FEET
Cam —
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE W LLL COMPLETED
DATE .OF REPORT
WELL DRILLER (Signature)
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0
Owner or Purchaser of Building
Building Constructed by
GCS J
zzw/
Locate - Street
Bui ing Type
G�2��OD?c'J
Municipality
Section
Block
J
Lot
GUARANTY 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 guaranty to the owner, his succes-
sors, 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 :Wade 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 de-
termination 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'�'b36 sthe willful or negligent
act of the occupant of the building utilizing th4 system.
0.
Dated this c�
day of �� 19� Signature
11 Title:
If corp '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 Courity Department of Health
PUTNAM COUNTY.- DEPARTMENT OF HEALTH
.O
Df►%isfon of 'Environmental Healfh: Services Carme% N Y 10512
CONSTRUCTION PERMIT FQ.R SEWAGE DISPOSAL SYSTEM :� ¢ ) - y -
O 'W- V.� I lag e
, or
'Located' at;
Section
Subdivision Lot
Bloc
� 1 Job
Owner - - Address
8uildmg TYPe Lot Area
" Nu`mber of Bedrooms `� TotaC'Habitabie Space Square Fret
Sep arate' {;Sewerage _System.%to consist of g�a Gal., Sept!c tank - lineal feet X _ width trench
To be, co.nstructed,^ by, _ ! `� �� ` Address _
Water Supply Public SuPPIY From
Private ;Supply t o be drilled by '' —o
Address,
z
Other Reguirements
S 4
i represent that 1. it wholly and. completely responsible for;the design -and location of Ahe proposed systems) .1) that `,the separatesewage di spgsal system
abo "ve described will be constructed as shown on -ttie approved amendment there: -to and in accordance with the'standards :rules an ,regulations o ' the'- -u nam
County- . 'Department of.•_.i?iealth and that on co- mpletion:the"reof a `Certrficate of ConstrucLon Compliance atisfactory to the Commissioner of-- Health will
•be:. u6rrfifted =to the Department :- and -a -written-;guarantee =will be =;furnished the owr er his successors heirs oc assigns :by the tiwlder; that said builder will!.
place in g ood operating condition any ';part of -said sewage dl3po5a1 system during _the period of tvvo, A 2)-years immediately' following the date of the Bid
ance of the. approval of Ahe Certificate';of Construction Compliance of= the on final'- system, or any `repaus, thereto 2) `that,the drilled Weil.described above
wil6beaocated ass .. oe.the approved plan and that said well will be installed jn rdance ,with . 7 the; standar s rules and regulations' of the Putnam,
County Dye /gyp /air /tmerit of 'l le�naflth 1 ' /
Date! ' �i OZ O /97 Signed = P E
Address License No��+��
-APPROVED FOR - +CONSTRUCTION This = :approva expires y :r_fr�omthe d issued, constructiorr „of the tw�ldmg,,has been undertakeq and is
revocable: for cause or maybe amended or, modrfied when' i ed necessary, the nor of Health_ Any,''chi. -,or alteration of s<onstruction
requires; a n ;per A roved for- di @posal'of do a anitary sewa” n. r >: water supply ,o.nly
,
•
•`: Date - _w .. _ - _
Title
y
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL'HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner % / /�/1� �G�. G Address
Located at (Street ec. Block Lot
dlc e n res cross street)
Municipality c IA/1 > Watershed %Z
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
RLM apse Depth to Water Water ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
US 10 H I
2
3
4
2
3
4
5
Notes: 1) Tests to be repeated at same depth until apppproximately 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.
2 /a . S,75 -'0 o
S
13- /5z /
W.'40 -/L/0 /o
/t7
US 10 H I
2
3
4
2
3
4
5
Notes: 1) Tests to be repeated at same depth until apppproximately 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.
6"
12"
18"
24"
30"
36"
42"
4811
5411
60"
M
7211
78"
84"
TE *T-PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO.____ HOLE N0. HOLE N0.
INDICATE LEVEL AT WHICH GROUND WATER -IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
DESIGN -
Soil Rate Used �f0Min/l "Drop: S.D. Usable Area Provided %5-0T0'U
No. of Bedrooms Septic Tank Capacity 9)6. Gals. Type
Absorption Area 'Provided By L.F.x24'— width trench.
01 99
Address 2 SEAL
LLJ
i � pE 043eg�' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: " "'� ��FFSSI....
Soil Rate Approved Sq. Ft /Cal. Checked by " " " "� Date
,
rill-MD CI;FX' LIST
�a
Date.: 3 /
Insp . by:
INITIAL SITE IPd�PECTION
Yes
No
Comments
Property lines or corners found
.
Can estimate house location ..
Will driveway need cut . .
Must trees be removed -note these . . . '. . . .
Is deep hole representative of entire SDS area
Additional deep holes needed. . .
Sufficient SDS area available considering
dr.i.veway cut, house location, separation ,
distances, etc. . . . . . . . . . . . . . .
DEEP ?IOI1E DATA
Iapth : l �
Water elevation: ® >
Rock elevation: O
Soils description:
e:
-T-
�INAI, SITE INSFECTION Ins by:
House located where shown on approved plan. ...
S1
'
. .._._.
IS' !nna.tPr3
V idth of trench average _
Slope of the line and trench acceptable .
Room al -lowed for expar_si on :trenches
Over 50 ft. from swamp., watercourse . . . . ...
.. Natual soil not st, pped or SDS area
uruecessarily.graded . . . .
.10 - . Uaintainsd from prop-line and
24 ft. from house . . . .
S°pa.�ation of trench from house, well
et,,-. follows plan . . . . . .
Nib ,,r of bedrooms checks . . . . .
StorLS, brush, stzurps, rubble, etc. greater
'L-bin- 15 ft . from r_earest trench . .
15 R. of peripheral soil horizontally from
' trench . . . . . . . . . . . . . . .
�r�csion boxes prope---ly set
CO3Uat surface run off from driveway, roads,
graund surface, etc. channel near SDS ,
a.iva . . . . . . : . . . . . . . . . . .
Does 1.ot drainage appear 0. K. in area of SDS
FIN& GRADING OF SITE ACCEPTABLE
Al
Meets Std.( Remarks
SEPARATION DISTANCE'S SPECIFIED ON PLAN
10' to P.Z.
20' to Foundation walls
100' to Nearest well
50' to stream, march, lake, etc. incl
.expansion
15' to Curtain drain I
10' to water line (pi7ts -20' )
15' to storm drain '
10' to large trees
0' from foundation to septic tank
5' to pipe from leader drain & fOOL1T]
Yes s
Pdo
DOCTTYMINTS �•:
House plans O.K.
/
' Design data sheet
Peres presoaked?
TUn. 30. pert test depth
Const. results for 3 runs
I
I
D. Hole log O.K.
i
I
Corporate Affidavit for other than individual
,L.�
I
Authorization for engineer
I
t
Letter from Water Supply if applicable
i
I
If variance requested -such noted on plans & apps.;
I
DETAILS
if change is proposed,)
Existing contours shown show new contours)
Slopes -for driveway cuts, etc. shown
+
Water service line location
Footing..drain, :etc. location
I I
Top slope.,. bottorn slope of fill
Percolation tests and deep.test pit.location
! ► r .
Septic tank size and conformance to std.
I
3 B. R. house minimum
,/ I
House setback shown
�G
Di "-'el'-Yu f;-,: st
-
I
.031.1 WCL Viii' NI J_ v1J.•1.11 �V 1 V • V1 A.�l .,. +v .•
Plan and profile SW
All other wells and SRS closer 200'
shown or reference made
Property boundaries (meteQ and bounds- clearly
shown' i
SEPARATION DISTANCE'S SPECIFIED ON PLAN
10' to P.Z.
20' to Foundation walls
100' to Nearest well
50' to stream, march, lake, etc. incl
.expansion
15' to Curtain drain I
10' to water line (pi7ts -20' )
15' to storm drain '
10' to large trees
0' from foundation to septic tank
5' to pipe from leader drain & fOOL1T]
jv
VMMAIO 1041111
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