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00277
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CER IFICATE'OF CONSTRU
TUTNAM-COUNTY:]
Division of Environihenisl:H,
NT OF EA
Permit i
10512,
SA' `SYSTEM :
Town &'VA1890
Located at. M;
Owner Formerly
Tax p Lot # Subd. Lot # P,
Separate Sewerage Systern built by Address
Consisting of Aambal. Septic Tank an 4RD6 L.-W -ion zk
Other requirements
Water Supply: Public Supply From
A!f- Private Supply Drilled By
Address
Building Type No., of Bedrooms Date Permit I ssuid
Has Eroslori Ccintrol'Been Completed?
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 a6cordanba with the fea plan, and the permit issutid'by"the
Putham County DeTtmentlof H!alth.
P.E
pate by �
xAd ;41? Lite n" No.—
Any person 'occupying premises served by the above systim(s) ihaii pr6rnptiy'take such action"as may be necessary to secure the correction of any unsanitary • it. M $hill b . y nec6
conditions resulting "from such usag6. Approvil of the Separate sewaraga,sy,e ec�orne null'and void as soon as a public.unitery sewer bioomes •
available. and the apipiovai of the,pOlvate water supply shall b . ecome,null'an"d, void. when it, . &,p66iIC'w&ter pply I becomes available. Such SpOovals are
0
Subject to modification or change 'when, In the Itidgment- ommIsgWqr 4 f "Health., `such re4.1Ar1nn, modification or change Is necessary,
�e Comml
Date BY Title'
.
'Owner or Purchaser of Building
Building Constructed by
0
Location - Street
Section
Block
Lot
Municipality Subdivision Name
Building Type 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-
ors, 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-
ation of the Director of the Division of Environmental Health Services
of the Putnam County Department.of Health as to whether or not 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. r.
Dated this day of ___19'V Signature
Title L
H
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
COUNTY OFFICC BUILDING - CARMEL. N[w YORK
This report is to be completed by well driller and .submitted to County - Health Department together with laboratory report of
•TSaly :i :of water sample indicating water is of sati :factory bacterialaubllty'bi:fore eertlficYle of construction compliance-is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF VVELL COMPLETION
MILL DRILLING. INC
NAME
ADDRESS
Pawlings Savings Bank Bldg.
OWFiER
Classic Homes Inc. Ic/o
Kent Dumont
Route 422 Brewster NY 10509
90CATION
IMO. L Str•ot)
(TotrnJ (Lot Nartnaer)
,C
�Z
of wru
Route 4311
Patterson, New
York /
®
BUSINESS
EI
0
►tOPOSED
DOMESTIC
ESTALL SHMENT
FARM
TEST WELL
ust OF
WELL
13
�j
n
n
SUPPLY
LJ WOUSTr1AL
CONDITIONING
L.1 (Specify)
DRlLtIHG
ROTARY
COY-PRESSED
P
D
Q OTHER
�QYtPX.Et(t
LJ
AIR RCUSSION
PERCUSSION
)
CASING
LEhGTM (uet)
DIAMEURpncltes)
WhtrMI PER FOOT
a THREADED WELDED
UI:IVE SHOE
! ='JYES
EINO
w.A;S CASING �U
I_IYES �NO
DETAILS
30
6
17
YIELD
FAILED
HOURS
PUMPED Q COMPRESSED AIR.
G.P.M.
YIELD (G.P.M.)
TEST
d
30
30
WATER
MEASURE FROM LAND
SURFACE— STATIC(Soocttyloet)
fleet)
DURING YIELD TEST lest)
of Completed Well
MILL
5
2255
In feet below land.surioce: 225
MAKE
L MOTH OPEN TO AQUIFER Ntail
SCRFEN
DETAILS
SLG1 Sii.:• +
DIAMETER (Mcnox)
IF GRAVEL
(
Diameter of well including
GRAVEL SIZE (inenes) FROM (lootl TO (loot)
I
PACKED:
grovel pock (incnefl:
I
:PTM PRGK tAND SJttACEI
FORMATION DESCRl7TION
Sketch •Tact locotion of well Willi atstences. to at least
FEET to FEET
Iwo porrranont
lanamaras.
0
20
Sand and gravel.
®.S°
20
225
Mede hard white limestone.
•
Oc,��tetilit/� td�
Joe,
If
yield wet testrd of difie.enl
depths ds.rinq drilling. list below
O
6l C,
FEET
GALLONS rER.MIMUTE
225
30
Rovr
it Witt comrttlto
DATC Of' ACf%OrZT
(,ton,t„t�
%VCLL ORILLCIt ) '
11/8/84
11/12/84
, Presiden
MILL DRILLING. INC
ELLIS A. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06810 WATER -WASTEWATER
PHYSICAL METHODOLOGY
BIOLOGICAL P.O. Box 246 203 - 748 - 7903 APHA - WQO - ASTM
REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER
NAME AND
SOURCE OF SAMPLE ADDRESS OF r Mill Drilling, g Water Supply, _ , Inca , Classic Homes Inc. _
PERSON TO Route 311
RECEIVE Putnam cue Patterson, N.Y.
REPORT p
Brl?wntpr N.Y. DATE '�'���� DATE OF COLLECTION NOV. lO; 1904
A4i11 Drilling
DATA COLLECTED BY
Hydrogen ]on
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
Concentration
LANGELIER
(PH)
RYZNAR
NTU
Mg /L
Alkalinity as CaCO 3
Fluoride (F)
Bicarbonate
Nitrite
Mg /L
Mg /L
Mg /L
NITROGEN
Alkalinity as CaCO 3
Chlorine Residual
CONSTITUENTS
Nitrate
Mg /L
Carbonate
Mg /L
Mg /L
AS
NITROGEN (N)
Total Hardness
as CaCO3
Ammonia
Mg /L
Mg /L
Mg /L
F minoid
Mg /L
Iron as Fe
Mg /L
Mg /L
Chlorides as CL
Mg /L
Manganese as Mn
Mg /L
Mg /L
Detergent as MBAS
Mg /L
Sulfate as SO4
Mg /L
Mg /L
The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST
one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50m1, 41100ml, 7/200m1, or 13/500m1 Colfform Colonies /100ML
in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) 0
More than five per cent of the samples when 20 or more are examined per month.
® 1. The results of the analysis of this sample are satisfactory and meet requirements for a potable water.
2. The results of the analysis of this sample satisfactory for a potable water but certain of the chemical or physical constituents are high. These
are as follows:
El3. This sample is not satisfactory since it does not meet the bacterial requirements for potable water. The presence of organisms of the coliform
group in a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does
Indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also Indicate that the
treatment was not adequate at the time the sample was collected.
El4. This sample is unsatisfactory as a potable water because certain chemical or physical constituents are above acceptable limits. These are as follows:
COMMENTS
A -1
r
Certified.................................................................................. .............................�-
U,
UT COUNTY
DEPARTMENT
�g `'/
�\ 10\
e
DI
'
visfop _p, qv rbnffi66tW;-HO4 i Srvices R Caren i
SYSTEM _.:
fSPOSAL
`-1`CONST13UCT1ON AdE
r -,,Town :.or7 Village
,.N
7
Lot
Block
SUM,. -Ibt
'of, Approval
C�ner/Addfes
t7 a n
66iiding Type4'
- Lot,
es
Number!ot- Bedrooms� n'
' �Ow.
R'
Sewerage Ta"K a
e rage s)i e, consist :_of.
e it
7z
vt�e, co by
•N.
From ply:.
Water S'66 i6, V
P
V !jv ate. Supply t
ttv A"
7,
Address
#7 J
Other . er Requirementi—f- J,
%
r
f
the 4i_ 6) -�jr) _ihi -separate sewage disposal system
re resent that I am whollry,�and:�cor�pl��oly,r,��sp�"�!P!,� tj -�Of,' the proposed .,SYS ern S j that sa
t
of
a ove he'apbr&6:14*in.�� 'andjn,-aqS' i�61�6siihdar la ions tne,, Putnam
b .'deifc;ib`9d �til;66�eonitrudeci asLikiwn on t cl�, rules r u
'and
kCounty, Department -i Construction Compliance' satisfactory Y" J sil6ner of Health,will
ti�at'or..cqm`pI'et,iqn �erpdf ai-i f 6 !9.the-_C6mm:
e subm, written,gdaran ee;'im ' ril _e rn c e 1� Su". th builder, that laid builder, w
ed "to' the Oel ccessors. he rs-or.�asSigns*bY., 0
'place 'inb�' f the4su-'
'pl -,J -goo�- b6eiratii�g conde;iop- pqy, "r,t of .,S4,! -�'Yea I edlitely following the.catelo
r :Coen . . — r I t 1'It, " j, . two (2) _abdVe.'r
- `the r pliance7lof.�.416i --sys em 't
va na ,
'fiance of C'Jjjtificate 6 Construction i' drilliod� wall del
d , r .: . I . ' AT9 Mago-
-.d well %iiiii-be"I'n—tall accor anc
s ri on he approve las',aAd iegu ns. of the, Putnam
pJaW.And thatsmi
County Do it h
V".
A.
p
"Address
Acense, No
�o
oca
amendment her
de f caie
P t:-*APPR)VED FOR CONSTRUCTION this . approval expires construction pq I f P.
H ing,�as_been,undertaken and; is
revocable Health
_for .,cause 'ror- may bi;in4n�i6il-br Moqj!jqd wqen(co dared necessary V, f. t4. n e Op-p�64iioA'
'.AQuiris-A new Approved -'for di sPP isai bf'd6hiiiii
a _ ply only
r
bate
lq�
,!Rev.' 9-81
4.11;
I
ri
PUTNAM COUNTY DEPARUEN'T OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner C_/3e �a��� �,,,�a-��it,C_Address 1� ;�'� v
Located at (Street -3(f Sec. Block Lot
indicate neares cross street)
Municipality 'Ra�—VAr"i Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Water Leve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Mi,n. /in drop
Inches Inches Inches
1 0- 10 lo 1 °7
V5 0
1
2
3
4
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE No. I r HOLE NO. HOLE NO.
G.L.
6"
1211 J
1811 ;
2411 i
3011
3611 c
42" -
4811
5411 a
60" cr
6611
7211
7811
8411 ,
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED C /
TESTS MADE BY �-- Date
DESIGN
Soil Rate Used IL-3 Min/1 "Drop: S.D. Usable Area Provi
No. of Bedrooms ?� Septic Tank Capacity jOOC) Gals. A
Absorption Area Provided By L. F. x24 a tre .�
` A h R
Name_ T: M r A-p. t nA 4-- igna ure
Address SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
4 k'- cKL -- CID"
CD,
Ilk
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