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00760
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rly': side Route
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1
PUT-NAM. COUNTY DEPAR'
Diwsfon'.of Environmental 'Health Ser
Fes-
�., aPprox _.1300
no
PMENT OF HEA'LTH'
hces,> Carmel;'.
N.": Y .:105.12 -
I §AL SYSTEM y :: Town of Patterson
Town 'or Village
Section
Block
1 poi 2 roe' 215J -552
t Joiiia. Cou hli'ri• Brewster I�. . ,
Separate Sewerage System built_,by - : g Address' • 10589,
Consisting of sal: Septic. Tarik - 180 lineal Feet X g6~ width trench
Other requirements
one
Water Supply Public-Supply From" o
{
Private i5upply Dulled ,By B .F Beal
D�ewst®r, N..Y6-1 -0509
Address
z:. _
Ponverted Barn Jtxl 2 1975
Bwlding TYP N
0 of ed 6o
ms m Date Permit Issued p i
as Erosion Control Been Completed �®
� t
x 1. certify ".that the'system(s) as listed serving the above premises were constructed essentially as shown on the plans of -the - ofy�(ch are
- ''attached), and :in`,accordance with the standards; rules and'regulat_ions plans filed,'and the,permit''issued by:: the. nam CountyOep�arim nt of HeaTiH�
Date July: 9, .'18 75
Be;LCgrti deb P. E., g R.A.
Address
t cicenserNo.
Any person occupying premises served by the above sy5tem(s) shall ,promptly take such action as may be necessary toaecure the correction of any ,unsanitary
_.conditions resulting. from -such usage: Approval. of tthe separate %sewerage system shall, iecome "nulPand void 'as soon as . a. Public sanitary. sewer 'becomes
available and the- approval of the private water supply. shall become null -' and void when'a.public water.- supply becomes - •available, Such approvals are
suliject•to modification. or change when, in the judgment of the.,C sion of Health,• cqn revocation" 'on oe change is, necessary..' .
r it y
� Date �- � f • � - �
-
4
Title
,r_ �,r ,� ..'7 ' .:t.` rbfi `' F •a*.1. -�'+ 3. ...�...'�' t.k2s..,,,ti..,. 1 ?.,. i",
fELL COMPLETION RE-PORT PUTNAm COUNTY DEPARTmrNT OF 14EALTI'l
Division of Environrrontal tic►iii,
COUNTY OFFICE EJUILDING - CARMEL. NEW YOI1K%
Thiv rcpo.-t is to be completed by driller and suI-•.-;iI-d To County Health Del - -).irimcnt together with laboratory rk•port of
analysis of water sampfe indicating water is of sitisfactery bacterial quality before certificate of construction cornplianciL IS issued.
-LL COMPLE N
REPORT MUST FIE SU'01.11TTED WITHIN 30 DAYS OF V,`, TIO,
OWNER
NAME ADDRESS
M. L. Lowenthal RD #6, Brewster, New York ..10509
. Ilia. 6 stfootj (Town) --- of
(Lo ;umc—)
-Route 164 New York
LOCATION
OF WELV
PROPOSED
WELL
9US114ESS - 7
DOMESTIC ESTABLISHMENT FARIA TEST WELL
PUCLIC AIR ER
SUPPLY INDUSTRIAL El CONDITIONING (STH
(Specify)
DRILLING
EGUIPME14T
F'j
COMPRESSED CABLE OTHER
ROTARY AIR PERCUSSION D PERCUSSION (Spe.ify).
CASING
'-DETAILS-
LENGTH (feet)
I DIAMETER (inches)
-tit
WEIGHT . PER F
1:9 lboso I'FLI THREADED WELDED
DRIVE SHOE
RIYES CINO
V.,AS A ING1G'-Qt:Tr5-?
ry --- 1
L--i YES NO
YIELD
UST
'HOURS G.P.M.
[1. CAI LED P9 PUMPED COMPRESSED AIR 6
YIE I LD (G.P.M.;
5
WATER
.LEVEL
MEASURE FROM LAND SURFACE -51ATIC(.5peCily feet) DURING YIELD TEST 11091)
17 ft.
Depth of Complelad Well
In feet below Land svrface.:.. 240 ft.
SCREEN
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (I. Cho.$)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (inches),, I FROM lfcor, 10 (loet)
TH FROM LAND SUZFACEI
FORMATION DESCRIPTION
Drilling in overburden (c
Skofch exact lo.-a::on Of well Wi'!? 04(311C&S, to at least
two permanent landmarks.
0
20
ay and boulders)
lloe7z
Hit solid.rock at 20 ft.
20
30
Drilling in solj,-:d rock--;se -;
30
240
Drilling in rock. (granite
If.y;*Id was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
WELL DRILLER (519natura) 'n 11, 10MI A T YNTO
}JUildxfig`'Con:itructc , d by
6 ' '
rl,ocation - Street
Building Type•
Mu�i.icipalaty - .I
Se(: ti
on
Lot
GUARANTY OF SEPARATE SUTAGE SYSTEM
I represent that I am wholly and completely responsible for the location, .
workmanship, materi ?l; construction and.drainage of the se(-.,age disposal syst=em
serving the ;above described property, and that it has been'constructcd 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 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 initial use of the sewage disposal system, or
any. repairs made by .me to_such..system, except where the failure to operates properly '
=Lfi(: ?- WIl:L1 I! (Jl' 11L'L�11�'t11L' dl L U1 (�1( OL:C!Updir. Vl 1.111 ✓LL11�111L - µ-.111411,b"
—
ti', e
The unc3ei;signed further agrees to-accept as conclusive the determination
of the Director of the Division of Environmental Health Services of the Putnam County
`pu�=ment of Health as to whether, or not the ...failure of the system to operate was -
eaused by the' willful or negligent act of. the occupant of the building utilizing, the
system...
Dated this' M day of LIU 19 Signature
7Z
Title
L f corpora ion, give name and addres
- -. - -- ---------- - ---------------------------------------------------------------
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE. CERTIFICATE
Or COMPLETION VILL BE ISSUED.
GUARANTOR IS RF.OUIRED TO. FILE NOTICE OF DATE OF •FIRST USE OF. SYSTEM.
.. -- - -----------r------------------------.+..............---------_------------------
Division of Environmental Health Services, Putnam County Department of Health
BREWSTER LABORATORIES
Box 224 - BRMSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 3459
SOURCE: Lowenthal — hose bibb — well supply
Route 164
Patterson, New York
COLLECTED: July 14, 1975
BY: PoF,Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
July 162 1975
0 Per 100 ml.
Bickwit P. E.
Director
SubdiVisicirif-
wjj
'
-"
�
o
it—ter soil
Town�ior' Village
"Se lock
fi
l X, Width 'teench
r e W's D509
Yi
f I'l 1' which has
n, ion
5
2
3
4•
5
Notes: 1)" Tests to be repeated at same'depth until approximatelyy 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.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
SIGN 'DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE
N0. 215J- 552
Owner Max L. Lowenthal, Jr.
Address R. D. 3. Brewster,N.
Y. 10509
Located at (Street) Roe 164'
Seca 15 Block 1
Lot 2
1300 ft +-. wes -t ckuudica e nearest cross s�re e
Couch Road
Muni ci lit Town of. Patterson
Pa Y
New York
Watershed
City
SOIL PERCOLATION TEST DATA
REQUIRED TO BE SUBMITTED WITH APPLICATIONS
4
_
o e
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
No. Time
p oat er Water ve
From Ground Surface in Inches Soil Rate
Start -Stop Min.
Start Stop Drop in
Min. /in drop
-10 :15 8
Inches Inches Inches
24.
8
110:07
.25
Min.
210:16 -10:23 7
24... 25 1
7 '►
310: 211. - 10:32 8
24 . 25 1
8
_
l 9:56 - i o: 04 8
24 25 1
.8
210:05-10:15 10
24 5. 1,
lo,t
310:17 -10 :37 20
24 26. 2
101t,
0" ,
5
2
3
4•
5
Notes: 1)" Tests to be repeated at same'depth until approximatelyy 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.
TEST PIT DATA 'REQUIRED : O BE.- SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
j
DEPTH N0. 1) {HOLE N0. (2) HOLE NO.
G.L. Topsoil Topsoil Topsoil j �; t•
611 , . ��: . , :�� .. _ ..� •I
sand It am. with
1211. .
Y ... �..::sandy loam with
1811 gravelly loan @.ome cl .y & stones some clay &I stones
24T1
Some' sand &.. clay .._._
3011
3611 . ..tt, .. : � -.' 1i Iii: • L',':.` '•i, tt• is ` •
4211. �. • ++ • . �, ��•�,4' _," . t��l .. • .fi:; +; rt 1 i •ii f
4811 t► ti tt ; ' i.
,� 1 I• 1 I
1 '
5411` sandy;'; gravelhy...:.._._._...sandy & grs.v. ®11y' •1
f
601t +, j
i
66i1 Le :dga 'ind1c9t16n
211 . (ho e not' Th
7811 Filed' a .... ...: ...fir ... .. ..... ........_.. _........__.._. .. ... .. �;i
,....
.tt
. I
841} +► �t
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 60"
INDICATE LEVEL TO WHICH, WATER: LEVEL RISES AFTER_ BEING G ENCOUNTERED 4a tt
;
TESTS MADE BY Bn Date March 10, 1975 j
U ate evel chebkod
DE 81
Soil Rate Used 10 Min/ltt_...Drop:. S.D.-Usable: Area. Provided5300 ' + -SF
j,
2 900
No. of `Bedrooms Septic Tank Capacity Type Precast conk . ®tie
Absorption Area Provided By..180 L.,E.x24tt 361f width trench. Other Fioldo
to be constructed. in- Ninc wxage..r. -,o. =b fill I
(Name Roy A. Burgess. Signature ;
Buropss •& Behr, P., .C, .. SEAL
Address ;
Glencida Ave-,.-.Car-me
120..... s
PUTNAM COUNTY DEPARTMENT OF HE
°�
s. ,q; A
Soil Rate Approved S ;G 1 1 y ec ed
.;4
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