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BOX 9
�7-
.., J NJ
. 16 _ -�
00766
Rev.
1/87
CONSTRU ON PERMIT FOR SEW.
Lec Aoute 164-
" I .
PUTNAM COUNTY DEPARTN
Division of Environmental Hedth SO
Tm,u or ru!lg. -
YellinrKh-U'ds.en.. 1 5 -,-..,2 '.,,l 6'. 2
Subdiv Won Name S66d. Let N Tax
Barabra Potvin & Mich4el Fast
Revislon-0
Oinuri/ApplIesuit,Name
Date of Previous Approval
NY , -10509
MallungAddress.. 49 Hudson rewster,,
n rive T Own 7' ZIP
Date Subdivision Approved Fee Enclosed :' Amount
Log Home 15 Acres+
Building Type Lot Aria All sec tion i0inly Do # P Volume
"
Three 600. ICHD Notification is Reqo� When FW Iscompleted
Number of Bedrooms— Design Fl 6 P D
1250- 480 L.F. Tile fields
Se Sewerage, System to 6onjUt of Gallon Septic Tank and
Patrick - 11 - I� 'Hill :R6a -NY
trick Typda vy Brewster, .05,09
To be construdeti -by Address
Water Supply. Mlic-tupply,From Addlrese
k , F F. Beal &I diviss P B6x-B, Brewste
r, NY 1009,
or Supply Drilled by .
Other Requirements
I represent that I am wholly and'c6nnpIeteIy respqnsiple'ior the design and location of the proposed systern(.00) that'the separate disposal system
o and iccordance with wage P8_8
above described will be constructed.&$ shown o I n the approved am I andment there t h the standards, rules and regu61-5n, .7 Putnam
County Depi►tinint of Health, anti that on completion thereof a "CertH'ice"to ''of-Constructl6n 'Compliance" satisfactory to the Commissioner, of Healtlivvill
be submitted t6 the,61pa'dMinii'. and 'a .written j6aiintii will.be Nrrilshed_thi owner; his ,.s9ccessorshilers,or as46s by the builder. that said builder Will
place in 'good opeiating eonditio'n any part o4 -laid' sawage�-dl*spossi systeni 'during . the p6rl6d of-two (2') y"isimmidiately following ifie"ti of the Issu-
4 ihi,ori inal system or-any're that the drilled well described above
ante of the approval of the Certificate of 'Construction Compliance, a. 9, Pi repairs t heiito; 2) t
will 60 located as shown'on the'approved'plan and that . . said well will" . the standards, rules and reg7ursTro—nsof the Putnam
be Installe(L' n accordance with
County Department of Health...;`
Date P.E. R.A.
..:7' pr
Address RD9'-Fair Cak.jW)"N.Y. 10512 License No- 29206
CONSTRUCTION: This approval eipires,tw6
APPROVED FOR Vaari:.f r6m the! date -issued unless construction''of the building has been undertaken and Is
,
ro4ocible for cause 1. se or. may be ame I nd ad or,m6dified.wheh considered necessary by the Commissioner .of Health. Any change or alteration of construction
requires a t Apir'dvecl -for cii.pojjtj:of 6ornestic sanitary sewage,"Snd�&, povpliavifler iy only •
epw permit. -z
DEPARTMENT OF HEALTH
Division.of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL O h
PCHD PERMIT # /- /�
WELL LOCATION
Street Add ess XG&MM11
G��
age City Tax Grid Number
�. Z
WELL OWNER
Name
�L.7
Mailing Ad ress
S
2.
SWrivate
0 Public
USE OF WELL
1 - primary
2- secondary
)3�R—E SIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY
0 FARM
0 INSTITUTIONAL
0 AIR /COND /HEAT PUMP
.0 TEST /OBSERVATION
0 STAND -B
O AB ANDONED
0 OTHER (specify
0
AMOUNT OF USE
A�Y
YIELD SOUGHT�gpm /# PEOPLE SERVED tU /EST. OF DAILY USAGE 6',005tal
0 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION 13 ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
•DRILLING
WELL TYPE
DRILLED
DRIVEN
ODUG GRAVEL.
O
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WEAL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
\/ r�( 110 ), cv 0a &—v Lot No.
WELL CONTRACTOR: Name
Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _k-'NO
NAME OF PUBLIC WATER SUPPLY:
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI D
,fgM—SEPARATE SHEET
(date) s
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted Linder the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putn County
Health De rtment.
Date of Issue: `r 19
01 C/ Permit IssuinT is
Date of Expiration: 19
Permit is Non - Transferrable Mite copy: H.D. File
Yellow copy: Building Inspector
Rev. 10/88 Pink Copy: Owner
Orange copy: Well Driller
IM1M!M;Mlwftwflw AlMIM1nA1nfIMIMInAInAIMInA1Ml! AInAIn Al nA1Ml lAln Ai MiMinAlMiw AiMIMIMIMI -All AIM: nA1M IM IMI MIMIMIAAIMUfIMIMIMInAIM1An1 ^Aln nlAnlMlMlnn w,
6
•4
1
1 I
1
b=,-o =,E.7T CF DI71ISiCj CF
Lu�?-iJC��L %ir'rr? cuP°LZ & �u�i F ��' Sr:'u��'- DIE?- ZL E_ —Mc
Rc'v v S--_- - CANS %ciirTCN P'I: -IT"
(Z3s._^ e of Lcc:tica) .
c� ^,�,T I YES I NO 1 CCC'�'�=
,e 0-,7 -e
Fe --mi t A=Iic- ticn
C.r-_cr3t- Resci t2.ca
Puns - Tnr e °_ ss4_=
E:ncineer AL't_1C_—_* C1
T'eSiCII Ccrr SQ�� ('C� �
CJ�c acid Lcc '.
Ccas
Psrc aci= C'-c`1
i
Ecusa Two
vc= icr -c -,Ra mses t
ca--- Cif lJL _..... (^,I
:C_;�LLcJ DTI j C-N
V-
F &
E -cL_-c TG.��
well CCTV_! L_ C`. c_
NLctes
De sicn rerc ar-d de c _
Drveaatr & Slcces Cat
r_c /G DL :`= =r,C,r _._ ii-iS
- Fcati
Perc & Ceeo Ecles L: c
Recrasa t✓tive cf
If Furor Pit -& D Ecx
ffcus� - Ira. cf Ee^r;!^
-wells & S: LS's W/z 20.0 ft. c= r` c-r-c-
Prccert-�j :•motes & EcU_d.
Ecuse Set�c'c Necssza r (Tic t 1ct)
Ecuse Serer - 1, /4" /f=. 4 "0; T_:= Pi e
x. Eer
No Bemcdss; W/
SE;A=IC-N D i S-'r, tiCL S= =C CN
Fie' ^..s
10' to P.L_, Dri-ve c-v, L — == T= =`,TC_ c� _
20' to FcLnc =.tica KEE 1=_
100, to well; 200' i^ D. r., ^.D,
1.00' to Stream, j�ct ='_�Li " =cj - = {� (ir1C. E:,_
15' to F ct -r1C
10.1 to at_r Line
S_ct C %nti=.
ICI
I
- =... E-rcT---
I - F---i°
10 f
--- - 4-1
cs t_n cauce-
tip—,
r
ff
Fe --mi t A=Iic- ticn
C.r-_cr3t- Resci t2.ca
Puns - Tnr e °_ ss4_=
E:ncineer AL't_1C_—_* C1
T'eSiCII Ccrr SQ�� ('C� �
CJ�c acid Lcc '.
Ccas
Psrc aci= C'-c`1
i
Ecusa Two
vc= icr -c -,Ra mses t
ca--- Cif lJL _..... (^,I
:C_;�LLcJ DTI j C-N
V-
F &
E -cL_-c TG.��
well CCTV_! L_ C`. c_
NLctes
De sicn rerc ar-d de c _
Drveaatr & Slcces Cat
r_c /G DL :`= =r,C,r _._ ii-iS
- Fcati
Perc & Ceeo Ecles L: c
Recrasa t✓tive cf
If Furor Pit -& D Ecx
ffcus� - Ira. cf Ee^r;!^
-wells & S: LS's W/z 20.0 ft. c= r` c-r-c-
Prccert-�j :•motes & EcU_d.
Ecuse Set�c'c Necssza r (Tic t 1ct)
Ecuse Serer - 1, /4" /f=. 4 "0; T_:= Pi e
x. Eer
No Bemcdss; W/
SE;A=IC-N D i S-'r, tiCL S= =C CN
Fie' ^..s
10' to P.L_, Dri-ve c-v, L — == T= =`,TC_ c� _
20' to FcLnc =.tica KEE 1=_
100, to well; 200' i^ D. r., ^.D,
1.00' to Stream, j�ct ='_�Li " =cj - = {� (ir1C. E:,_
15' to F ct -r1C
10.1 to at_r Line
S_ct C %nti=.
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of Qr�;-T-v r �4.
Located at
(T) b' i i� j�� Section • / Block Lot 2---
Subdivision of '��[ �:� (j
Subdv. Lot # Filed Map ## Date
Gentlemen:
This letter is to authorize �� : IA O
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
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani=
tary Code.
Cot signed:
P.E. , R.A. , #
PRE�,rs�� /�F
F�
3
G
2
- �
o
29206
Address ANN N. PRWISS, P.E.
R09 FAIR ST 914- 878 -6170
ORIEL. NEW PORK 1051
Telephone
Very truly yours,
Signed �iw ®&aet'd-
Owner of Property
Lik ►- ) VCso,, (p r,
Address
ibrews.�er N�( ) ysoq
Town
_ a -7--Y- 3
Telephone
P
PUTNAM COUNTY DEPARIlH M OF HEALTH
DIVISION OF ENVIRCNMRqML HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner OT1[ i N F A ST Address i y
Located at (Street) Sec. 1,� Block Z Lot /g"• L
(indicate nearest cross street)
Municipality 1T� ��I- Watershed C r--0- o /
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking Ll- (, - S cl Date of Percolation Test 4 - b Vic}
HOLE
NUMBER
CLOCK
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth
to Water From
Water Level
No.
Time
Ground Surface
In Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop In
Min /In Drop
Inches
Inches
Inches
2 P-oF1
1?
10
/O
4
5 zUS
-16-1
1 `f
2 3co 6 al L� %
3 alb 7-z-'5 10 iL -z- 3 I
4 61 3 3 3 L4 I I X 3
5 33y I-/ I1 ;-v -. Z
1
2
NOTES: 1. Tests to be repeated: at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be subaitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
r
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. -44-- 1 HOLE NO. HOLE NO.
G.L. c9 ►`c�c >T r-�
i
c-(? r. A I -) I c S
2'
5' IQ rPN U`Q.I
7' jf r4 w G a
9 00 Lite. Pacte- Noy �cr,r,F° lf,c.C_
,
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: \ q , v� u e rL DATE:
DESIGN
Soil Rate Used )6 =ZU Min /1" Drop: S.D. Usable Area Provided S y0G t
No. of Bedrooms -3 Septic Tank Capacity U gals. Type -�,o w a`I
Absorption Area Provided By t0 L.F. x 24" width trench cy )-9 Re
Other �— �aQEESSION�
Name
dumm H.
RENTISS, P.E.
RD9 FAIR ST 914- 878 -6170
Address CARMFI, NEW VAgIf 10512
GF�si NO 29pb
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by •'" Date
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1
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12%q
rite�Dottom of
french on grade
oft -4 %per to
i
from settling or b 1
dosing Conks -
earth to be tamped
tightly around
distribution box
DUAL
DISTRISUTIOld
4'j2( solid pipes
i
from sepnic.tun
OVERFLOW
SYSTEM
WH
rZ
fiy dalhlf :
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w,o;
12%q
rite�Dottom of
french on grade
oft -4 %per to
i
from settling or b 1
dosing Conks -
earth to be tamped
tightly around
distribution box
DUAL
DISTRISUTIOld
4'j2( solid pipes
i
from sepnic.tun
OVERFLOW
SYSTEM
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